The final report for the Adolescent Health Risk Appraisal Project

Fife Symington, Governor
State of Arizona
Jack Dillenberg, D.D.S., M.P.H., Director
Arizona Department of Health Services
ARIZONA DEPARTMENT OF HEALTH SERVICES
OFFICE OF WOMEN'S AND CHILDREN'S HEALTH
1740 West Adams Street
Phoenix, Arizona 85007
6021542 - 1880
Permission to quote from or reproduce materials from this
publication is granted when due acknowledgement is made.
September 1993
OfJie of the Director
1740 W. Adams Street
Phoenix, Arizona 85007
(602)542- 1025
(602)542- 1062 FAX
FIFE SYMINGTON, GOVERNOR
JACK DILLENBERG, D.D.S ., M.P.H.,D IRECTOR
To My Fellow Arizonans and Other Interested Parties:
The Adolescent Health Risk Appraisal Project Report summarizes the results and
recommendations of a three year study. We hope that you find it a valuable resource in your
efforts to develop community programs that address adolescent health issues.
A fundamental function of the Arizona Department of Health Services is to identify health issues
specific to Arizona. The method we selected to identify adolescent health issues was to
implement the Adolescent Health Risk Appraisal (AHRA) Project in schools throughout Arizona.
We used a computerized AHRA developed by the Rhode Island State Health Department and
targeted 8th and 9th graders.
This strategy was selected because it provided a Win - Win - Win situation for all involved.
* The students received personalized positive health messages based on their responses to
the questions, a list of community resources and the message that they could improve
their health by decreasing their risks.
* The schools received the aggregate data for use in program planning and curriculum
development.
* The Department of Health Services received information on adolescent knowledge,
beliefs and behaviors which are essential for surveillance, planning of health services and
prevention programs.
It is always our pleasure to work with you to find new and innovative approaches to ensure that
Arizona adolescents are able to grow and become healthy, productive adults.
Dillenberg, D.P.s., M.P.H.
-Leadership for a Healthy Arizona -
When reviewing this Final Report of the Adolescent Health Risk Appraisal Project, it is important
to keep in mind that the findings are representations of 8th and 9th grade students from across
the State of Arizona. This document is a compilation of their self-reported responses to the
Wellness for Teens Questionnaire. As self-reported information, there is an awareness that some
responses may not be as reliable as direct observation. However, what is more critical is that
these self-reported responses represent what the adolescent population feels and reports as being
true, for them. For this purpose alone, it is a valuable contribution to our understanding about
adolescents in Arizona. Without their willingness to respond, the information presented here
would not be available.
The Arizona Department of Health Services, Office of Women's and Children's Health gratefully
acknowledges the many contributions and support received from:
School Administrators, Counselors, Nurses, Teachers, Parents and Students, and
Community Agency Staff who participated in the Adolescent Health Risk Appraisal
The Rhode Island Health Department for providing the Risk Appraisal Program and valu-able
consultation and technical assistance;
The Consultants and Support Staff from The Office of Women's and Children's Health;
Joanne Gersten,Ph.D. from the Office of Planning and Evaluation; the staff from the
Arizona Department of Health Services Offices of Administrative Support, Health
Education, Nutrition, Dental Health, HIV/AIDS, and Chronic Disease Epidemiology; and
the staff from the Comprehensive Health Unit of the Arizona Department of Education.
Special recognition goes to Mark Newall, a South Mountain High School 9th grade student
who won the Adolescent Health Logo Design Contest.
Very special acknowledgement to Susan Wolf, Ph.D. whose patience, persistence, and expertise
contributed to the existence of this document.
It is hoped that the reader of this document will use the information to contribute to the improved
health status of Arizona's Adolescents.
Funding for The Adolescent Health Risk Appraisal Project and Final Report were provided through the Arizona Department of
Health Services, Office of Women's and Children's Health from Maternal and Child Health Block Grant Funds.
Document Creation, Page Layout and Graphic Design by Wattle & Daub Consulting, Tempe, Arizona.
All materials presented within this report are available through the Arizona Department of Health Services, OEce of Women
and Children's Health, 1740 W. Adams, Room 200, Phoenix, AZ 85007.
The Arizona Department of Health Services is pleased to present The Final Report of the Adolescent
Health Risk Appraisal Project (AHRA). It's purpose is to provide invaluable information to all who
have an interest in Adolescents and their health. The Project was created with four goals:
1. To gather information necessary to guide the improvement of health status and quality of ado-lescent
life in Arizona by assessing their current health status and risk taking behaviors;
2. To determine what areas can be sgn&cantly impacted by knowledge of adolescent health status;
3. To analyze the existing data in order to provide recommendations to persons, systems, and
communities for improving adolescent health; and
4. To determine the risk areas which need prioritized attention in conjunction with innovative
strategies to meet the Healthy People 2000 Objectives for Arizona's adolescents and young adults.
This report is divided into five sections: Introduction, Findings, Outcomes, Recommendations, and
References. A detailed description of the Implementation Methods is provided in Appendix E.
Significant findings suggest that adolescents, experiencing constant changes to physical, emotional,
intellectual, and social selves, are developing health habits and behaviors which place them at higher
risk for future health problems, including a shortened life span. Areas of greatest concentration in
the Risk Appraisal focused on:
d Diet and Nutrition d Dental Health d Immunization Status
d Physical Fitness d Smoking d Stress
d Family History of Disease d Alcohol and Other Drugs d Sexuality
d Traffic Safety including: d Cancer Screening For Females
Seat belts Use and Speeding
Helmet Safety
Hitchhiking Behaviors
The overall health status of adolescents, based upon the AHRA data, suggest that there are signifi-cant
differences among the various ethnic groups represented within the Appraisal Project (i.e.,
Anglos, Blacks, Hispanics, Native Americans, Asian/Pacific Islanders and Others). Furthermore,
there were significant differences found between the genders on several issues (e.g., physical fitness,
dental health, traffic safety, and alcohol an other drug use). Details of these highlights are captured
in a Summarized Highlights section at the end of the Findings section. Specific details for each of the
above-mentioned areas are presented in the Findings section.
Outcomes from the AHRA included immediate interventions for two students who notified the ADHS
Staff that they had experienced suicidal ideation. Also, two-thirds of the participating schools indi-cated
that the AHRA data had assisted them in planing, developing and implementing programs
based on the aggregate data which they received from their students who participated in the Health
Risk Appraisal.
Recommendations:
1. THERE SHOULD BE AN ACTIVE SCHOOL-PARENT-STUDENT-COMMUNITY* PARTNERSHIP IN
EVERY SCHOOL and/or COMMUNITY.
2. THERE SHOULD BE AN ONGOING, STATE-WIDE ASSESSMENT OF ADOLESCENT KNOWLEDGE,
ATTITUDES, BELIEFS, AND BEHAVIORS IN CONJUNCTION WITH A DATA COLLECTION SYSTEM.
3. ADOLESCENTS MUST BE INVOLVED IN THE PLANNING, IMPLEMENTATION, AND EVALUATION
OF HOLISTIC, COMPREHENSIVE, AND SEQUENTIAL EDUCATIONAL AND SKILL BUILDING PRO
GRAMS AS WELL AS DIRECT SERVICES.
4. THE PARTNERSHIP SHALL PLAN, IMPLEMENT, AND EVALUATE COMPREHENSIVE, CULTURALLY
SENSITIVE SCHOOL- AND COMMUNITY-BASED PRIMARY (PREVENTION), SECONDARY (INTER-VENTION)
AND TERTIARY (POST-INTERVENTION) PROGRAMS, SERVICES, AND ACTIVITIES IN
EACH SCHOOL and/or COMMUNITY.
5. THERE SHALL BE COLLABORATION BETWEEN STATE / COUNTY / CITY / TOWN OFFICIALS
TO PROVIDE ADEQUATE FUNDING FOR APPROPRIATE CONSULTATION AND SUBSEQUENT
PLANNING OF PROGRAMS, SERVICES AND ACTIVITIES IN EVERY SCHOOL AND CONQVIUNITY.
6. PROGRAM EVALUATION WILL BE INCLUDED IN THE PLANNING PHASE FOR ALL PROGRAMS,
SERVICES, AND ACTIVITIES WHICH ARE CREATED AND THAT THE EVALUATION PROCESS
WILL BE AN INTEGRAL COMPONENT TO ANY PRIMARY, SECONDARY, OR TERTIARY PRO-GRAM,
SERVICE, OR ACTIVITY.
Given these recommendations, which are based on results from the AHRA and underwritten by initia-tives
within the Arizona Department of Health Services, there are several specific areas that are
addressed with respect to the Healthy People 2000 Objectives. The specific health status, risk reduc-tion,
service and protection objectives as well as research needs are presented which focus on the fol-lowing
areas: Motor Vehicle Crash Injuries, Homicide and Suicide, Lifelong Health Habits, Tobacco,
Alcohol and Drugs, and Sexual Behavior.
* NOTE: Community includes representation from other community residents (e.g., health care providers, business, industry,
and the religious community).
Introduction. 1
WIUkT IS THE ADOLESCENT HEALTH
The Project Purpose
RISK APPRAISAL
The Current State of
Adolescent Health
Those who are concerned with
and about adolescents are well
aware of the multifaceted and
inter-related issues concerning
adolescent health. Not unlike
similar-aged youth from across
our nation, Arizona adolescents
are faced with these same ongo-ing
concerns. They focus on
their transitions in physical,
social, and psychological/emo-tional
development, their expo-sure
to risk-taking situations
and their associated behaviors.
All of these issues collectively
impact upon their current and
future health status, as depicted
in the Figure on page 2.
Understanding this interplay of
issues, events, and behaviors,
research has supported the need
for (1) increased awareness of
current health status, (2) early
identification of teens at risk, (3)
presentation of effective and
non-threatening information
needed to make behavioral
change, and (4) the implementa-tion
of comprehensive preven-tion
and intervention strategies
(e.g., school-based,
community-based) .
Startling facts, based upon 1990
statistics, include:
+ 2 1.5% of Arizona youth
age 12 to 1 7 live in families
below the poverty level
($12,700 per family of four),
+ 14% of Arizona youth (ages
10- 18) are uninsured,
The Arizona Department of
Health Services (ADHS), Office of
Women and Children's Health
(OWCH) was interested in
addressing and understanding
@e health of adolescents in
Arizona since there was a scarci-ty
of available data regarding
adolescent health risks. The
Adolescent Health Risk
Appraisal (AHRA) Project was
developed as a needs assess-ment
to collect data and identify
health risk areas, both in terms
of their severity and prevalence.
Furthermore, implementation of
the Health Risk Appraisal pro-vided
a means to increase the
level of health awareness and
delivery of health education to
students, school administrators
and Project-affiliated staff.
PROJECT?
+ 12% of Arizona's children
had no usual source of
health care,
+ 17% of Arizona's adoles-cents
(ages 13-18) need
mental health services due
to behavioral and/or emo-tional
disturbance,
+ 4982 of Arizona females aged
1 7 or younger became preg-nant
(rates of 63.8/ 1,000
young women ages 15- 17
and 2.1 / 1,000 for those age
1 5 and under),
4 34% of the 1 1,502 cases of
chlamydia (an STD) were
identified in Arizona adoles-cents
aged 15- 19,
+ 47.5 deaths per 100,000
Arizona 15- 19 year olds
occurred due to uninten-tional
injuries,
+ 16.1 suicides per 100,000
Arizona 1 5- 19 year olds
occurred, with Native
Americans experiencing a
40.2 per 100,000 rate, and
+ 10.7 deaths per 100,000
Arizona 15- 19 year olds
occurred due to homicide.
Given this information, it is
apparent that a majority of these
statistics represent preventable
situations. Furthermore,
Arizona adolescents, who consti-tute
14% of the state's popula-tion,
are in great need of contin-uing,
effective, comprehensive
strategies to support their
healthy growth, development
and survival.
Pilot testing of the AHRA Project
procedures occurred during the
1988- 1989 academic school
year. Revision of procedures,
policies, and materials based on
participant feedback occurred
prior to implementation during
the 1989- 1990 year (details in
Appendix A). The most impor-tant
additions to the AHRA
Project were the ADHS-created
Wellness for Teens booklet and
Two Fact Sheets: Wellness for
Teens-Teenage Depression and
Suicide and Wellness for Teens-
AIDS (Appendix B). The booklet
was distributed to each partici-pant
during the Project's imple-mentation,
while the Fact Sheets
were distributed upon request.
The Project generated a 'WN-WIN-
WIN" situation for all
involved. It provided individual
health information to students,
aggregate data for schools and
districts, and surveillance infor-mation
for the State.
Components of the Adolescent Self 0
0
The AHRA Project
Components
The Adolescent Health Risk
Appraisal (AHRA) Project utilized
an individualized, computerized
data analysis program that was
developed by the Rhode Island
Health Department in 1983. The
target population (8th and 9th
grade students) was determined
based upon research which indi-cated
that school dropout was
consistently higher in 10th
through 12th grades. As a
result, it was proposed that a
representative sample of 8th and
9th grade students from across
the state of Arizona be selected
for this project to provide maxi-mum
impact for early awareness
of adolescent health-related
issues and information dissemi-nation.
The program consisted of a 46-
item life style questionnaire
(both males and females
answered the first 40 questions,
with girls completing an addi-tional
6 items (questions num-bered
4 1-46) (see Appendix A).
The questionnaire covered the
following topic areas with
emphasis on the types of behav-iors
which adolescents may have
engaged in on a regular basis:
Diet and Nutrition
Dental Health
Immunization Status
Physical Fitness
Smoking
Alcohol and Other Drug Use
Traffic Safety-including:
Seat belts Use and Speeding
Helmet Safety
Hitchhiking Behaviors
Stress
Sexuality
Family History of Disease
Cancer Screening For Females.
Upon completion of the Teen
Wellness Check Questionnaire,
each student was given his/her
Teen Wellness printout which
provided feedback about individ-ual
responses, including both
general and individualized
health messages (see Appendix
B). In addition, students were
given accompanying resource
materials including two booklets
entitled The Way to Wellness for
Teens, and the ADHS Wellness
for Teens (see Appendix C) and a
list of community resources for
each major area covered in the
Risk Appraisal. School-deter-mined
optional Fact Sheets
(Wellness For Teens-Teenage
Depression And Suicide and
Wellness For Teens-AIDS) were
also distributed as part of the
student information packet
when deemed appropriate (see
Appendix D).
A Post Data Conference was
conducted at the end of each
school's participation as a
means of sharing aggregate data
findings. Those in attendance
often included school
Administrators, various staff
members, and health care pro-
.fessionals. Recommendations
based upon Project findings for
further cumculum, program,
and project development were
discussed with the ADHS staff
person, the AHRA Project staff
person, and others that were in
attendance.
Three months after the AHRA
Project implementation was
completed, the ADHS staff per-son
responsible for the AHRA
Project sent the participating
school personnel a follow-up let-ter
and questionnaire. This fol-low-
up procedure assisted in
identifying any further imple-mentation
of strategies and/or
1develop-
Participating Arizona Counties ment of
programs
and cur-ricula
based
upon the
AHRA
findings
for that
particular
school. A
complete
descrip-tion
of
project
, imple-
I menta-tion
is
located in
Appendix
Demographic
Description of the
Student Sample
The final AHRA data set consist-ed
of questionnaire responses
from 7278 eighth and ninth
grade students representing 47
different schools. Of those 47
schools, seven schools had their
population surveyed during both
the first and second semesters
and 10 of the schools requested
the AHRA for two consecutive
school years. These 47 school
were located across the state
with 1 1 of 15 counties being
represented (see State Map
inset).
Ten of the 47 schools did not
meet the policy minimum of
50% of grade level participation
in the AHRA. However, their
data were retained because of
completion of at least 25% of
those surveyed and the provi-sion
of feedback during the Post
Data Conference. Conversely,
nine of the schools had greater
than 90% participation. One
school, with both 8th and 9th
grades surveyed, had greater
than 90% participation from
both grade levels, indicating a
strong commitment and support
for the AHRA Project.
Demographic information for the
7278 respondents included in
the final reported analysis were
+ 5 1.5% (3750) 8th graders
+ 48.5% (3528) 9th graders
with
+ 50.1% (3647) males
+ 49.9% (363 1) females.
Additional information for the
7278 respondents included an
analysis of the responses to Q5.
When asked what was the high-est
grade that they anticipated
to complete, the respondents
indicated that:
(/ 83.1% wanted to complete
college
(/ 12.1% wanted to complete
high school
(/ 4.8% were not planning on
completing high school.
I I
Educational Aspirations of the Sample
Education Level Frequency Percent Cum Percent
<= 8th GRADE 48 0.6 0.6
9th GRADE 5 1 0.7 1.3
10th GRADE 2 1 0.3 1.6
1 1 th GRADE 233 3.2 4.8
12th GRADE 878 12.1 16.9
COLLEGE 6047 83.1 100.0
Age Distribution of Sample
Years Frequency Percent Cum Percent
13ORUNDER 1758 24.2 24.2
14 2973 40.8 65.0
15 2134 29.3 94.3
16 382 5.2 99.5
17 2 7 0.4 99.9
18 OR ABOVE 4 0.1 100.0
Findings. I
WlMT WERE THE FINDINGS FROM Excellent Health Risk Status
THE AHRA
Major Findings by
Questionnaire Topic
The findings from the AHRA
Project are summarized in the
following section. Overall Health
Risk Status is presented first,
followed by presentation of each
questionnaire item. The individ-ual
questionnaire items are
reviewed in the order of appear-ance
within the questionnaire
(Appendix A) and referenced by
question number. Tables
include the AHRA question and
its basic frequencies, percentage
of responses, cumulative per-centages
and the median and
modal responses for each ques-tion.
Since the first nine ques-tions
addressed various demo-graphic
characteristics of the
respondents and have been
summarized in the previous sec-tion,
they are not repeated here.
In addition to the documenta-tion
of Project Findings provided
in this section, there is a com-plete
summary of the frequency
of responses for each question-naire
item in the Wellness
Check. It is based on the total
sample of 7278 respondents.
The summary is presented in
table form as a reproduction of
original data that was shared in
a Post Data Conference in
Appendix F. Furthermore, the
19 individual risk data elements
which were presented as feed-back
in the Teen Printouts are
reproduced and located in
Appendix G for all 7278 Project
participants.
PROJECT? "Excellent" health status sug-gested
that the student was
making healthy and safe choices
Overall Health Risk in the majority of areas and had
attained a numeric health score
Status
As a result of completing the d Only 29.5% of those adoles-
Adolescent Health Risk cents surveyed received
Appraisal, each student received "Excellent" health status on
a Teen Wellness Printout that the AHRA.
rated their responses and gave
feedback to them about their Fair Health Risk Status
es to the AHRA questions that that the student was making
were weighted for response, healthy and safe choices in
each student received a Health many of the areas, however,
Risk Score. want to look at where healthy
choices were not being made.
Their numeric health score
appear on a Teen Wellness 4 5 1.3% were given "Fair"
printout. They included the health status.
Health Risk categories of
"Excellent", "Fair", "Risky" or
"Hazardous". Examples of each
are presented in Appendix H.
Risky Health Risk Status
"Risky" health status suggested
that the student was making
unsafe and unhealthy choices in
many areas. Furthermore, some
of these choices were in areas
identified by the AHRA computer
program as being particularly
risky to one's health. Their
numeric score ranged from 55 to
69.
(/ 14.6% received a "Risky"
health status.
Hazardous Health Risk Status
"Hazardous" health status sug-gested
that the student was
making unsafe and unhealthy
choices in the majority of areas
and the associated numeric
score was at or below 54.
d 4.6% received a "Hazardous"
rating.
Analyses were completed to
compare overall health status
scores with respect to several
demographic variables, includ-ing
ethnicity, age, and gender.
Results indicated that all demo-graphic
descriptors, with the
exception of gender, produced
significant differences in the
mean level of health status rat-ing.
There were several differences
among comparison groups when
analyzing differences in mean
Health Risk Status Scores on
the AHRA. Most noted, there
were significant differences in
mean scores among different
ethnic groups, with
Asian/Pacific Islanders
@J=80.22), Anglos m=79.04),
and Blacks @J=78.35) adoles-cents
experiencing significantly
higher Health Risk Status rat-
HEALTH RISK CATEGORIES
Score Frequency Percent Cum Percent
EXCELLENT (85- 100) 2 148 29.5 29.5
FAIR (70-84) 373 1 51.3 80,8
RISKY (55-69) 1066 14.6 95.4
HAZARDOUS (0-54) 333 4.6 100.0
Total Sample 7278 100.0 100.0
Median 2.000
Mode 2.000
Ethnic Group Frequency Mean SD I ANGLO 4426 79.04 1 1.27
HISPANIC 1749 74.76 1 1.06
BLACK 403 78.35 9.77
NATIVE AMERICAN 309 7 1.82 13.95
ASIAN / P.I. 131 80.22 10.95
OTHER 260 76.94 12.58
Total Sample 7278 77.61 1 1.52 I "Statistically Significant; E (5,7272) = 54.76; Q < .00001 I
Age Group Frequency Mean SD
13 YEARS OR UNDER 1758 78.95 10.06
14 YEARS 2973 77.60 1 1.44
1 5 YEARS 2134 77.58 1 1.87
16 YEARS 382 72.35 14.10
17 YEARS 27 70.12 1 5 -44
18 YEARS OR OLDER 4 72.50 13.18
Total Sample 7278 77.61 11,52
"Statistically Significant; E (5,7272) = 23.45; Q < .OOOOl
Findings. 2
ings than Hispanic M=74.76)
and Native American (M=7 1.82)
adolescents. In ternls of reported
frequencies by Health Risk
Category, Native American youth
were disproportionately repre-sented
in the "Risky and
"Hazardous" categories.
Analyses were also completed to
determine if their were differ-ences
in Health Status as a
result of age. When the data
were represented as Health Risk
Categories, analyses indicated
that those older adolescents
(25.7%) were almost twice as
likely to be categorized with
"Risky" Health Status as those
who were age-for-grade appro-priate
(14.0%). Furthermore,
older adolescents (12.3%) were
three times as likely as younger
adolescents (4.1%) to be catego-rized
with "Hazardous" Health
Risk Status.
Although not statistically differ-ent
in all categories, it was noted
that there were differences
found with respect to gender.
Males (198) were 50% more like-ly
than females (135) to receive a
"Hazardous" rating, regardless of
Findings. 3
Diet and Nutrition
The Adolescent Health Risk
Appraisal Project gathered base-line
diet and nutrition informa-tion
from questions about eating
patterns among adolescents.
Overall, for breakfast eating
behaviors (Q 10) :
(/ 5 1.2% of adolescents eat
breakfast at least five
days per week
(/ 24.2% of adolescents eat
breakfast at most one
day per week or miss
breakfast completely
d Adolescent females (1 147)
were twice as likely to miss
breakfast regularly when
compared to males (6 12)
d Males were 50% more likely
to eat breakfast regularly
(five or more days/week)
then females
(/ Those with 'Excellent' or
'Fair' Health Risk Status
(2500) were ten times more
likely to eat breakfast every
day than those categorized
with a Health Risk Status of
'Risky' or 'Hazardous' (23 1).
QUESTION 10: How many days in a typical week do you ea
breakfast?
Response Frequency Percent Cum Percent
EVERY DAY 273 1 37.5 37.5
5-6 DAYS / WEEK 990 13.6 54.1
2-4 DAYS / WEEK 1798 24.7 75.8
1 DAY OR NONE 1759 24.2 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1,000
Response Frequency Percent Cum Percent
EVERY DAY 2570 35.3 35.3
5-6 DAYS 1 WEEK 2274 31 -2 66.6
2-4 DAYS / WEEK 2000 27.5 94.0
1 DAY OR NONE 434 6.0 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1.000
Response Frequency Percent Cum Percent
DAILY 3259 44.8 44.8
AT LEAST 3 TIMES / WK 2677 36.8 81 -6
SELDOM 1278 17.6 99.1
NEVER 64 0.9 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1,000
Findings. 4
With respect to daily consump-tion
from the four food groups
(911):
d 86.5% of adolescents eat
from the. four food groups at
least 5 days / week
d 6.0% of adolescents eat
from the four food groups at
most 1 day / week or do not
eat from the four food groups
at all
d There were no significant
gender differences in regu-larly
eating from the four
food groups
d Native American and Black
adolescents were more likely
to not have a balanced diet
than their Hispanic and
Anglo counterparts
d Those with 'Excellent' or
'Fair' Health Risk Status
(2289) were eight times more
likely to eat balanced meals
daily than those categorized
with a Health Risk Status of
'Risky' or 'Hazardous' (28 1).
The AHRA question which
focused on snacking behaviors
(Q12) (e.g., candy, sweets, pas-tries,
soft drinks, and sugary
foods) yielded:
d 44.8% of adolescents were
snacking daily
d 36.8% of adolescents were
snacking at least three
times / week
d Only 18.5% of respondents
snacked seldom (17.6%) or
never (0.9%) snacked
d Anglo adolescents were the
most likely (62.3%) to snack
on sweets on a daily basis.
Dental Health
The Adolescent Health Risk
Appraisal provided some base-line
information on several den-tal
health issues including den-tal
hygiene behaviors (913,
Q14) and utilizing preventative
dental services (Q15). These
patterns were not statistically
significant for differences among
ethnic groups, age, or grade
level. However, there were gen-der
differences in dental hygiene
behaviors
The data indicated that:
d 13.1% of adolescents,
regardless of ethnicity, do
not brush their teeth daily,
with 4.7% of those surveyed
stating that they seldom
(4.0%) or never (0.7%) brush
their teeth
d Males were seven times more
likely to never brush their
teeth on a regular basis
when compared to females
d Only 36.8% of adolescents
dental floss at least three
times per week, indicating
that 39.0% seldom floss
their teeth and 24.1% state
that they never floss
d Males were 50% more likely
to never dental floss when
compared to females.
QUESTION 13: How often do you brush your teeth ?
Response Frequency Percent Cum Percent
DAILY 632 1 86.9 86.9
ATLEAST3TlMESlWK 619 8.5 95.4
SELDOM 290 4.0 99.3
NEVER 48 0.7 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
QUESTION 14 How often do you use dental floss on your teeth
and gums?
Response Frequency Percent Cum Percent
DAl LY 980 13.5 13.5
AT LEAST 3 TIMES / WK 1700 23.4 36.8
SELDOM 284 1 39.0 75.9
NEVER 1757 24.1 100.0
Total 7278 100.0 100.0
Median 3.000
Mode 3.000
Findings. 5
not had their teeth cleaned
or checked in the previous
12 months
t/ The lack of consistent dental
care was greatest for
Hispanic (36.5%), Black
(34.0%) and Native
American (33.0%).
These reported behaviors, in
combination with elevated levels
of both snacking behaviors and
tobacco usage, provide evidence
of the need for access to and uti-lization
of products and services
to promote good dental health.
Response Frequency Percent Cum Percent
YES, BOTH 4126 56.7 56.7
YES, ONE 805 11.1 67.8
NEITHER 227 3.1 70.9
DO NOT KNOW 2120 29.1 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
Immunization Status
The Adolescent Health Risk
Appraisal addressed immuniza-tion
status regarding two dis-eases
(916).T he diseases men-tioned
were measles and
German measles (rubella).
These patterns of responding
were significantly different for
ethnic groups.
Of the adolescents surveyed:
(/ 56.7% responded that they
were immunized for both
measles and German
measles
(/ 1 1.1% responded that they
were immunized for only one
of the diseases
(/ The remaining 32.2% felt
that they were either not
immunized (3.1%) or
were unsure of their immu-nization
status (29.1%).
(/ Those with 'Excellent' or
'Fair' Health Risk Status
(3502) were six times more
likely to be immunized than
those categorized with a
Health Risk Status of
'Risky' or 'Hazardous' (624).
No data was collected on immu-nization
status for tetanus.
Also, there were no questions
related to when the most recent
vaccination(s) or booster(s) had
been received.
I Response Frequency Percent Cum Percent I I
Median 1.000
Findings. 6
Physical Fitness
The Adolescent Health Risk
Appraisal provided needs
assessment information with
respect to adolescent activity
levels and fitness (Q17,Q 18,
Q19) and produced an overall
wellness rating and categoriza-tion
of Health Risk Status.
Patterns of behaviors for differ-ent
between males and females
were noted.
In summary of the Physical
Fitness Questions:
(/ Overall, 55.9% of adoles-cents
walk at least one mile
three times per week without
stopping,
(/ 35.6% seldom walk one mile
and 8.5% do no significant
walking.
(/ 64.5% surveyed do 20 min-utes
of non-stop aerobic
activity at least three times
per week
(/ An additional 18.0% do aer-obic
activity one to two times
per week, while the remain-ing
1 7.5% seldom or never
do aerobic activity
(/ 65.4% participated in recre-ational
activities at least
three times per week
(/ 15.7% do recreational activi-ties
one to two times per
week, while the remaining
18.8% seldom or never do
recreational activities
(/ Males were 50% more likely
to participate in daily recre-ational
and aerobic exercise
than females.
Response Frequency Percent Cum Percent
DAILY 1901 26.1 26.1
AT LEAST 3 TIMES / WK 2167 29.8 55.9
SELDOM 2590 35.6 91 -5
NEVER 620 8.5 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 3.000
Response Frequency Percent Cum Percent
DAILY 281 1 38.6 38.6
AT LEAST 3 TIMES / WK 1885 25.9 64.5
ONCE OR TWICE / WK 1308 18.0 82.5
SELDOM 920 12.6 95.1
NEVER 354 4.9 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1.000
I Response Frequency Percent Cum Percent I DAILY 3074 42.2 42.2
AT LEAST 3 TIMES / WK 1689 23.2 65.4
ONCE OR TWICE / WK 1146 15,7 81.2
SELDOM 1 064 14.6 95.8
NEVER 305 4.2 100.0
Total 7278 100.0 100.0 I Median 3.000
- Mode 3.000
Findings. 7
Smoking
When adolescents were ques-tioned
about their tobacco con-sumption
(either cigarette smok-ing
or chewing tobacco) (Q20):
d 75.4% stated that they had
never used either tobacco
form
d 13.4% stated that they had
already quit using tobacco
d 8.0% acknowledged using
tobacco (cigarettes or dip)
regularly, but less than one
pack or dip per day
d 1.8% regularly use one pack
or dip per day
d 1.4% regularly use more
than one pack of cigarettes
or one dip per day
d Male adolescents were 33%
more likely to smoke tobacco
or use smokeless tobacco
then females
(/ Anglo and Native American
adolescents were more likely
to use more than 1 pack or
dip/day than their Hispanic
or Black counterparts
When those who used tobacco
were questioned about quitting
(Q2 1) :
d 38.4% were going to quit in
the near future
d 18.9% were going to quit by
the time they finished high
school
d 1 1.2% were going to quit by
the time they were 2 1 years
old
QUESTION 20: How many cigarettes (tobacco) do you smoke ?
Response * Frequency Percent Cum Percent
NONE, NEVER SMOKED 5490 75.4 75.4
NONE, I QUIT 978 13.4 88.9
1 PACK OR LESS / WK 404 5.6 94.4
MORE THAN 1 / WK 174 2.4 96.8
BUT LESS THAN 1 / DAY
1 PACK / DAY 131 1.8 98.6
MORE THAN 1 / DAY 101 1.4 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 3.000 * Includes both cigarettes and dips
QUESTION 21: If you are a cigarette smoker, do you plan on quit-ting
some day ?
Response Frequency Percent Cum Percent
I DO NOT SMOKE 6375 87.6 87.6
NO PLAN TO QUIT 173 2.4 90.0
IN NEAR FUTURE 347 4.8 94.7
BEFORE OUT OF H.S. 171 2,3 97.1
BEFORE TURNING 21 101 1.4 98.5
IF FORCED TO QUIT 11 1 1.5 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1.000
d 19.2% were not going to
quit.
d Adolescent males (172) were
50% more likely not to quit
or to be forced to quit than
female adolescents (1 12)
When these same adolescents
were questioned whether smok-ing
marijuana was more likely to
cause cancer than tobacco
smoking (Q22):
d 37.8% said there was no
relationship between
marijuana and cancer.
d 12.3% would quit only if
they were forced to quit
Findings. 8
(/ 62.29h stated "Yes" to
knowing that there are more
cancer causing agents pre-sent
in marijuana smoke
than tobacco smoke.
young cohort group (median age
= 14). When questioned about
the most alcohol consumed in
any one day in a typical week
(Q23):
Alcohol and Other
Drug Use
The adolescents who responded
to the AHRA indicated a relativc-ly
high usage of alcohol as a
d 85% of adolescents stated
that they do not consume
alcohol
QUESTION 23: In a typical week, what is the most alcohol you
drink in any one day ? (A drink of alcohol is either a 12 oz, beer, a
5 oz, glass of wine, or a 1 1 /2 02, shot of hard liquor). In a typical
week, the most in any one day is ...
d 15% stated that they con-sumed
alcohol on any one day
d Males (74) were four times
more likely to consume 1 1 or
more drinks in one day than
females (19).
In contrast to belief, it was not
those who were older adoles-cents
(older than 16) who con-sumed
high levels of alcohol.
High levels of alcohol consump-tion
occurred equally among all
ages groups surveyed.
Response Frequency Percent Cum Percent
NONE, I DON'T DRINK
1-2 DRINKS / DAY
3-4 DRINKS / DAY
5-6 DRINKS / DAY
7-8 DRINKS / DAY
9-10 DRINKS / DAY
11 OR MORE / DAY
Total
Median 1.000
Mode 1,000
When these same adolescents
were questioned whether alcohol
and other drug abuse were dan-gerous
(Q24):
d 93.3% of those surveyed said
"Yes", while
d 6.7% stated "No" to their
knowledge of the dangerous
Findings. 9
nature of alcohol and drug
abuse.
When alcohol is mixed with
other drugs (Q25), the AHRA
respondents identified that
d 1.5% often mixed drugs and
alcohol
d 1.8% sometimes mixed
drugs and alcohol
d 3.6% seldom mixed drugs
and alcohol
d 82.1%donotinixdrugsand
alcohol.
Alcohol and Driving
When asked if adolescents had
ever driven while under the
influence of alcohol or other
drugs ($326): I
(/ 2.9% admitted to drinking
and driving often, or riding
in a vehicle of a driver often
under the influence of
alcohol or drugs.
(/ 5.9% noted that they some I times drank and drove or
were a passenger with a
driver who'd been drinking
(/ 9.2% stated that they did
drink and drive or were a
passenger, but that it was
seldom in occurrence.
(/ Males (124) were 50% more
likely to drive or be a pas-senger
in a vehicle where the
operator was under the
influence of alcohol and/or
drugs than females (84).
However, the majority of those
adolescents who participated in
the AHRA Project (82.1%) stated
that they did drink and
drive, nor were they ever a pas-senger
in a vehicle under the
control of someone who was
drinking and driving.
Seat belt Use and Speeding
The AHRA questionnaire includ-ed
two questions focused on
traffic safety beyond the issue of
drinking and driving behaviors.
The first question (Q27) asked
how often Lhe adolescent wore a
seat belt when they drove or
rode in a vehicle. Overall. the
results indicated that:
4 55.2% almost always or
always wore seat belts
4 25.5% sometimes wore seat-belts
4 9.3% seldom wore seat belts
(/ 10.0% never wore seat belts.
-, I hour b I 1/ 20.0% often exceeded the
speed limit by 10 miles per
II hour.
Although there were no signifi-cant
difference in traffic safety
behaviors among ethnic groups,
the adolescent males (6.9%)
were five times more likely to
often exceed the speed limit
than females (1.3%).
Findings. 10
The second question (Q28)
asked how often the adolescent
exceeded the speed limit by
naorc than 10 miles/hcur when
jrnijng. Since a majority of stu-d
e ~ t(s7 9.4Oh) in this sample
were not yet driving, the remain-
~xig2 0.6% answered that:
d 34.4% never exceeded the
speed limit by 10 miles/hour
(/ 22.2% rarely exceeded the
speed limit by 10 miles/hour
(/ 23.4% sometimes exceeded
the speed limit by 10 miles/
Response Frequency Percent Cum Percent
NO, I DO NOT 5973 82.1 82.1
YES, OFTEN 208 2.9 84.9
YES, SOMETIMES 427 5.9 90.8
YES, BUT SELDOM 670 9.2 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
0
a
a
a *
0
(I,
a
a*
0
e
e*
0 **
0
0
0 *
(I,
a
*e
m
0
0
*
a
0
*
@
0 *
0
Helmet Safety Pedestrian Behaviors
ed one question (Q29) focused ed two questions about pedestri-an
behaviors. The first question
lescent wore a helmet, the jogging in traffic. When ques-results
indicated that: tioned about direction of walking
in traffic, adolescents indicated
d 39.6% stated that they did
not ride mopeds or motor-cycles
or bicycles d 29.5% walk and/or jog
facing oncoming traffic
d 6.2% almost or always wore
helmets d 30.7% walk/jog in the same
direction as traffic
d 6.3% sometimes wore hel-mets
d 39.8% walk/jog on either
side of the street.
d 5.5% rarely wore helmets
Although these behaviors may
d 42.5% never wore helmets. not seem risky, it must be
remembered that many of the
In general, female adolescents respondents to the AHRA reside
(66.8%). However, females were
50% less likely to even ride on There were no significant differ-
Findings. 1 1
The second question on pedes-trian
behaviors (Q31)a ssessed
the use of reflective clothing
after dark when walkingjogging
or bike riding. When ques-tioned,
adolescents indicated
that:
(/ 16.0% often wore reflective
clothing
(/ 26.7% sometimes wore
reflective clothing
d 29.1% did not wear reflective
clothing after dark
(/ 28.2% did not walk/jog or
bike ride after dark.
There were significant differ-ences
between male and female
adolescents, with females having
indicated that they were two and
one-half times more likely to gmJ
walk, jog, or bike after dark than
male adolescents of the same
age group.
The third question, (Q37),
focused on one aspect of suicide,
that of suicidal ideation. It
asked if the respondent had
experienced any ". ..feelings that
life was not worth living". In
response:
(/ 52.8% had not experienced
feelings that life as not worth
living
(/ Of the 47.2% who had some
feelings that life was not
worth living; 12% responded
often, 2 1.8% responded
sometimes, and 13.5%
responded rarely.
Of those who often or sometimes
have feelings that life is not
worth living, there were signifi-cant
differences among male
and female adolescents. Girls
(1538) were 50% more likely to
experience these feelings com-pared
to boys (9 15).
This pattern was also true for
those who were two or more
years older than their grade
cohort (those 16 years of age or
older). They, too, were 50%
more likely to experience the
feelings that life was not worth
living, when compared to those
age 15 or younger.
The fourth question ($38) refer-enced
the adolescent's availabili-ty
of a "support system" (friends
or family that they can turn to).
In response:
(/ 9 1.4% of adolescents stated
that a support system was
usually available (72.1%) or
sometimes available (19.3%)
(/ 8.6% of surveyed adoles--
cents stated that they have
-no support system available.
Percent Cum Percent
YES, SOMETIMES
Median 4.000
Adolescent males were 50% adolescents (9.2%) who have
Given the previous information,
a more in-depth picture was
achieved by looking at Question
37 and Question 38 simultane-ously.
It is alarming to note
that 324 (4.5%) of the total sam-ple
of 7278 adolescents sur-veyed
had experienced thoughts
that life was not worth living
.either often or sometimes and
these same youth did not have
any support system available to
them. For an additional 665
Findings. 13
Sexuality
The AHRA did not specifically
address the sexual behaviors of
the 8th and 9th graders sur-veyed
during the AHRA Project.
It did, however, address several
issues related to knowledge of
consequences of sexual activity.
The first question (Q39)a sked
the respondent "Can sexual
intercourse, even once, without
effective birth control, result in
pregnancy?" The findings indi-cated
that:
(/ 8 1. .7% responded "Yes"
(/ 5.5% stated "No"
(/ 12.8% were unsure of the
answer.
When analyzed by gender, it was
significant that twice as many
males (267) felt there was no
relationship between one sexual
encounter and the possibility of
pregnancy when compared to
female adolescents ( 134).
Of interest, there were signifi-cant
differences in the number
of adolescents who responded
"No" or were "Unsure" of the
response to the consequences of
unprotected sexual activity.
Native Americans (36%) and
Hispanics (28%) were most likely
to state that pregnancy was not
a consequence of unprotected
sexual activity, or that they were
unsure of the consequences.
When comparing the responses
of those who were unsure, how-ever,
there were no significant
differences between the number
of males (498) and females
(433). There were also no signif-icant
differences in responding
to Question 39 when comparing
Response Frequency Percent Cum Percent
YES 5946 81.7 81.7
NO 40 1 5.5 87.2
NOT SURE 93 1 12.8 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1.000
Response Frequency Percent Cum Percent
YES 6065 83.3 83.3
NO 265 3.6 86.9
NOT SURE 948 13.1 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1.000
Health Risk Status groupings.
Findings. 14
The second AHRA question
(940) addressed the issue of
multiple sexual partners and the
associated increased risk of con-tracting
sexually transmitted
diseases (STDs) . The results
indicated that:
d 83.3% responded "Yes"
d 3.6% responded "No"
d 13.0% were unsure of the
correct answer.
When analyzed by gender, it was
significant that more than twice
as many males (18 1) felt there
was no relationship between
multiple sexual partners and the
possibility of contracting STDs
when compared to female ado-lescents
(84).
Again, there were significant dif-ferences
in responding when
comparisons were made among
the ethnic groups surveyed.
There were significant differ-ences
in the number of adoles-cents
who responded "No" or
were "Unsure" of their answer to
the consequences of multiple
sexual partners and increased
risk of contracting STDs. Native
Americans (30%), Hispanics
(24%) and Blacks ( 19%) were
most likely to state that STDs
were not a consequence of mul-tiple
sexual partners, or that
they were unsure of the conse-quences.
Female Health
The last six questions of the
AHRA were answered only by
female adolescents, concerning
issues of their own health.
When questioned about their
own breast cancer prevention
behaviors (monthly breast self
exam) (Q4 l), female adolescents
note that:
d only 17.6% conducted
monthly breast self-examinations
d 82.4% not completing
regular, monthly breast
exams.
And this lack of preventive
health behavior was not signifi-cantly
different among ethnic
groups or between grade levels.
However, these same female
adolescents were quite informed
with respect to knowledge of
family history related to breast
cancer (542). Findings indicat-ed
that:
d 89.0% were aware that
there was no breast cancer
in their family
d 5.6% knew that cancer was
present
d 5.4% did not know or were
unsure of their family health
status in relationship to
breast cancer.
Response* Frequency Percent Cum Percent
YES
NO
Total
Median 2.000 * Only female responses
Mode 2.000
Findings. 15
When questioned about their
family histories with respect to
any female members having had
a hysterectomy, these female
adolescents were quite knowl-edgeable
of their family history
(Q43). Findings indicated that:
(/ 70.1 % were aware that
female family member had
had a hysterectomy
(/ 14.9% knew that someone
had had a hysterectomy
(/ 15.0% did not know or were
unsure of their female family
member's health status.
There were no significant differ-ences
found among ethnic
groups or among age groups.
When asked about their own
health and the regularity of their
menstrual cycles (Q44):
(/ 84.1% had not had a period
that lasted more than ten
days
(/ 7.9% had experienced peri-ods
lasting more than 10
days
(/ 8.0% had not started men-struating
yet.
Again there were no significant
differences in responding among
ethnic or age groups.
When questioned further regard-ing
irregular periods, those
experiencing irregular periods
(greater than 10 days in dura-tion)
(Q45) noted that:
(/ 56.8% did not know the
cause or reason for the
extended or irregular men-strual
cycle
DO NOT KNOW
"Only female responses
son(s) for their period lasting
10 or more days. There were several additional
questions that were asked of all
tions focused on other areas not
specifically addressed by topic
among those who smoke ciga-rettes
and use The Pill (Q46),
The results from analysis indi- Family History of Disease
cated that:
The AHRA surveyed adolescents
(/ 35.3% knew about the were somewhat informed with
increased risk
no increased risk of blood
tain what relationship exist- family history of disease
ed.
(/ 24.4% were aware that there
Again, there were no significant were none of the mentioned
differences found among ethnic diseases found in their fam-groups
of female adolescents, or ily or among near relatives.
among age groups.
(/ 32.4% did not know or were
unsure of the family history
for heart attack, stroke, high
blood pressure, or diabetes.
Analysis of the data revealed
that there were no significant
differences between males and
females, or among age groups or
I
Findings. 16
Environmental Safety
The second question asked
respondent if they knew whether
there was a fire detector in their
home or apzirtment and whether
the device was working (Q32).
The results of this question to
assess one aspect of environ-mental
safety and risk reduction
indicated that:
t/ 62.4% had smoke detectors
in their residence and they
knew it to be in working
order,
(/ 15.6% either did not know if
they had an alarm(4.5%)
or knew they had one but
did not know if it was func-tional
(1 1.1%)
t/ 22.1% said there was no fire
detector in their home or
apartment.
The third question assessed the
swimming safety of adolescents
(934) in order to determine one
component of unintentional
injuries. This issue is central to
all children in Arizona as annual
statistic from 1990 data suggest
a rate of 2.7 per 100,000 for
unintentional drownings in ado-lescents
14- 19 years of age.
Although this statistic has been
reduced since 1980 from 7.1, it
is still an alarming and pre-ventable
situation.
AHRA adolescents indicated
that:
t/ 93.8% could swim safely
Response Frequency Percent Cum Percent
YES 3144 43.2 43.2
NO 1779 24,4 67.6
DO NOT KNOW 2355 32.4 100,O
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
QUESTION 39: Do you have a smoke detector In your home or
apartment ?
Response Frequency Percent Cum Percent
NO 1605 22.1 22.1
YES, IT WORKS 454 1 62 -4 84.4
YES, BUT UNSURE IF 807 11.1 95,5
IT WORKS
DO NOT KNOW 325 4.5 100.0
Total 7278 100,O 100,O
Median 2.000
Mode 2.000
QUESTION 34: Do you know how ta swlm or stay afloat In water
hat is OYW your head 3
Response Frequency Percent Cum Percent
YES
NO
Total
Median 1.000
Mode 1,000
t/ 6.2% were unable to swim or
stay afloat in water over
their heads.
Findings. 17
Summarized
Highlights
Based on the findings from the
Adolescent Health Risk
Appraisal, the following summa-ry
of the major findings are pre-sented
here.
+ Less than 30% of the 7278
8th and 9th grade adoles-cents
surveyed received
an Excellent Health Risk
Status rating
+ Five percent received a
"Hazardous" Health Risk
Status rating
+ Anglos, Blacks, and Asian/
P.I. adolescent's self-reported
results indicated that they
were healthier than their
Native American and
Hispanics counterparts
+ Almost 25% of adolescents
Eat breakfast at most one
time per week or miss break-fast
completely, with girls
being twice as likely as boys
to miss breakfast regularly
+ Native Americans and Blacks
were more likely to have
a balanced diet when com-pared
to their Hispanic and
Anglo counterparts
+ 13% of those surveyed do
-not b rush their teeth daily
+ Males have worse dental
hygiene (brushing and
flossing) than females
+ With respect to immuni-zation
for measles and
German measles, only 57%
of adolescents reported being
immunized
+ Approximately 25% of the
adolescents surveyed do not
do physical activity on a reg-ular
basis (less than 3 times
per week for recreational
activities, aerobic exercise,
or walking)
+ Males were 50% more likely
to participate in physical
activities on a regular basis
when compared to similarly
aged females
+ 75% of those surveyed noted
that they had never tried
tobacco (in either form of
cigarettes or smokeless
tobacco (dips))
+ Anglo and Native American
adolescents were more likely
to be heavy tobacco users
then Hispanic or Black
adolescents (more than one
pack or dip per day)
+ 85% of those surveyed had
identified that they do not
consume alcohol on a daily
basis
+ Heavy alcohol consumption
(more than 6 drinks in a day)
was greatest for Native
American adolescents
+ 7% of those surveyed self-reported
that they do mix
drugs with alcohol +
+ 18% noted that they had
engaged in drinking and
driving, or had been a pas-senger
with someone who
had been drinking
+ Almost 20% of those sur-veyed
noted that they seldom
or never wear seat belts
Findings. 18
+ Only 6.2% of adolescents
regularly wear a helmet
while biking or cycling
+ Over 90% of those adoles-cents
surveyed do not hitch-hike
or pick up hitchhikers
1 + 47% of respondents noted
that they had feelings that
life is not worth living
+ 8% of adolescents noted that
they had no support system
available to them
+ Over 18% of adolescents did
not know that sexual inter-course,
even once, without
effective birth control can
result in pregnancy
+ Over 16% were unsure or
disagreed with the statement
that multiple sexual partners
increases the risk of con-tracting
STDs
+ 82% of females did not do
monthly breast self-exam
+ One-third of those surveyed
did not know what their fam-ily
history was for heart
attack, stroke, high blood
pressure, or diabetes
+ Two-thirds of those surveyed
had smoke detectors in their
homes and knew them to be
functioning
+ 6% of the respondents could
not swim or stay afloat in
water over their heads
Based on these findings, it is
imperative to utilize this infor-mation
in an effective manner to
address the health of Arizona's
adolescents. The next section
will address this concern.
+ Three programs (10%) were
expanding their current pro-grams
to include the school
nurse as an informational
resource person who will
actively participate in the
educational component of
their health cumculum.
WHAT WERE THE AHRA PROJECT
OUTCOMES?
+ One school noted that their
next "Retreat Day" was going
to be focused on the issues
and topics raised as a result
of the information from the
AHRA Aggregate Data.
Immediate
Interventions at Time
of AHRA
Implementation
In addition to the continued
support for the Project by
administration and staff within
the schools, their involvement in
the Post Data Conference and
Program Planning, two immedi-ate
outcomes took place as a
result of the AHRA Project.
First, there were a series of "In-class
Discussions" that resulted
from the process. On many
occasions and at different
schools, in response to the ques-tion
about family disease histo-ry,
much discussion evolved and
many questions were generated.
There were specific questions
and particular emphasis on dia-betes,
heart disease, breast can-cer
and high blood pressure.
Second, there was "Immediate
Intervention Counseling" provid-ed
on at least two occasions. As
a result of the AHFU Project, two
students identified themselves to
the ADHS staff person as at risk
due to suicidal ideation and
attempts. Because of the poli-cies
related to crisis interven-tions
and available staff, these
students were referred immedi-ately
to the classroom teacher
who in turn walked each stu-dent
to the counselor's office.
However, follow-up information
was not made available from
these interventions for purposes
of this report.
When asked if there was any
additional information that the
participants felt was missing
from the ADHS Wellness for
Teens booklet, there were five
specific areas that were men-tioned.
Follow-up Contact
Three months after the AHRA
Project had been completed in
any school, a follow-up letter
and questionnaire were sent.
Each of the 47 participating
schools received the follow-up
materials. While 15 schools did
not respond to the follow-up
contact, there were 32 question-naires
that were returned and
the results are presented in the
accompanying Table on page 3.
Of significance, the data indicat-ed
that:
+ All 30 programs indicated
that the materials they had
received through the AHRA
Project (i.e., educational
information and resource
listings) were helpful.
+ 28 of the 30 (93%) schools
requested that the AHFU be
made available and offered
on site in the future, with
one school promoting
district-wide implementa-tion.
+ Six schools were implement-ing
new programs which
included DARE, QUEST,
CHAMPS, a Substance
Abuse Support Group, a
Wellness Program, and
Suicide Crisis Intervention
Program.
First, there was a need for a
Male Section, similar to the last
six questions which comprise
the AHRA, but focused on male
sexuality and health. Second,
there was a request for a section
devoted to problem solving and
decision making. Third, there
was a request for a section
focused on Stress in Teen Life.
The fourth request was for more
information on AIDS, in addition
to the optional Fact Sheet. And
fifth, there were several requests
for information on Sexual
Activity and Sexually
Transmitted Diseases, with an
emphasis on behaviors and their
consequences.
Outcomes. 1
School-based
Curriculum
Development
From information received
through the Follow-Up
Questionnaire, it was identified
that numerous schools had
implemented changes and addi-tions
to their current curriculum
as a result of information
obtained from the AHRA Project.
As noted in the previous Table, a
considerable number of partici-pating
schools had made
changes or were in the process
of making changes to their cur-ricula.
Most notably, curricu-lum
changes included:
+ 63% in Alcohol and Drugs
+ 57% in Nutrition
+ 53% in Depression and
Suicide
+ 43% in Adolescent Sexuality
+ 43% in Stress
+ 43% in Tobacco Usage.
As noted previously, there was a
trend toward addition of specific
health objectives to address
areas which had been highlight-ed
through the AHRA Project
process and Post Data
Conference. These additional
objectives were to be targeted
and taught through already
existing courses and classes
such as physical education, sex
education, and Alternative Skills
classes. However, development
of specific health skills such as
breast self-examination and tes-ticular
examination met with
disapproval from the School
Board at one participating
school.
Furthermore, and most impor-tantly,
there were no statements
from responding schools regard-ing
the development of and
instruction in skills which would
be both comprehensive and inte-grated
throughout the cunicu-lum.
Program Planning and
Development
Although there were 28 schools
(59.6% of all participants) that
identified changes to their cur-ricula
and current programs
within their school, the informa-tion
regarding specific program
development was limited. As a
result of receiving their school's
aggregate AHRA data and
responding to the Follow- Up
Questionnaire, responses indi-cated
that there has been an
increased awareness among
adolescent students regarding
their health issues.
Furthermore, schools have
implemented several
school-based programs. To
date, however, there have been
no Community-based Programs
identified that were implemented
or a currently being implement-ed.
In addition to program planning,
development, and implementa-tion,
the AHRA had another sig-nificant
outcome. Several
responses from the three-month
follow-up letter focused on rhe
usefulness of the AHRA Data for
"bottom- line" issues. Each
respondent wrote an explanation
of how the AHRA data con-tributed
to change in their sys-tem.
Specifically, the Aggregate
Data results from the AHRA
Project were shared with School
Board Members in order to (1)
justify funding for additional
education programs and expan-sion
of current curricula and (2)
to defend current budgets for
existing programs when budget
cuts were eminent. This type of
justification with tangible evi-dence
from the AHRA provided
these schools with the necessary
ammunition (data) for the bud-get
battlefront.
their health, with the adolescent
at the center.
As depicted, these entities must
work, actively, in a coordinated
effort to enhance the current
levels of adolescent health in the
state of Arizona. They must
form partnerships, coalitions,
and alliances to benefit the
youth of Arizona by collectively:
UTHAT ARE THE RECOMMENDA-TIONS
FOR ADOLESCENT HEALTH
BASED UPON THE AHRA PROJECT
+ identifying effective courses
of action to be taken on
global and specific issues
related to adolescent health;
FINDINGS?
Improving Adolescent
Health:
A Comprehensive
Approach
As described in the Introduction
and exemplified in the previous
sections, adolescent health is a
multi-faceted and complex inter-play
of issues, events, and
behaviors. As depicted in the
graphic representation of the
adolescent on page 2 of the
Introduction, the adolescent can
be viewed as a complex system
experiencing continual changes
in their social, emotional, intel-lectual
and physical selves.
Having an awareness and
understanding of these integrat-ed
systems within our youth
demonstrates a need for a com-prehensive
approach to meeting
all their health care needs (i.e.,
medical, behavioral, and dental).
In order to begin to better serve
Arizona's adolescent population
with respect to improving their
health, promoting their future
development, and assisting in
their continued survival, what is
recommended is a broad-based,
culturally-sensitive, comprehen-sive
approach to adolescent
health issues. This comprehen-sive
approach must include the
cooperative efforts of all those
involved with adolescents in
Arizona. The approach must
encompass several influential
entities.
+ locating resources, acquiring
funding, and implementing
programs;
Influential Entities
+ Teens, themselves
+ Family members
+ Educational Institutions
(Schools, Districts, and
The Arizona Department of
Education [ADE])
+ Voluntary Health
Agencies and Service
Organizations
+ Community Groups inter-ested
in Adolescent Health
+ Religious Community
+ Public Agencies
(Departments of Health
Services, Education,
Transportation, Economic
Security, and Governor's
Councils)
+ Health Care Providers
(Primary Care, Specialists,
Dental)
+ The Media
+ The Legislature
+ Private Sector
(Corporations, Small
Businesses, and
Entrepreneurs)
The graphic presented on Page 2
is provided to help visualize this
interplay of the entities involved
in promoting adolescents and
+ evaluating programs on a
consistent and ongoing basis
to determine effectiveness;
and
+ prioritizing adolescents in
the state of Arizona.
The caveat to the following list of
recommendations is that the
model can not dismiss its
responsibility to the total ado-lescent
within his/her environ-ment,
even though a single
problem or situation may be
addressed from within this
framework (e.g., street violence,
suicide, teen pregnancy, alcohol
abuse, nutrition). It is the holis-tic
approach to family systems
that must not be ignored.
Furthermore, the adolescent,
who is central to this model,
must grow in the understanding
that their health is their own
responsibility. It is controlled by
the continued choices that each
individual makes on a daily
basis.
Recommendations. 1
Influential Entities
Recommendations
Recommendation # 1.. .
THERE SHOULD BE AN
ACTIVE
SCHOOL-PAFtENT-STUDENT-
COMMUNITY*
PARTNERSHIP IN EVERY
SCHOOL and/or COMMUNITY.
Since the health of Arizona's
adolescents is everyone's con-cern,
no one agency, system, or
provider can handle the problem
alone. With concerted, coordi-nated
partnerships, committed
to- improving adolescents' health
and well-being, many of these
adolescent health problems can
be resolved.
It requires partnerships, among
all the entities, but particularly
among the adolescent, his/her
family, their school, and their
community. Within this part-nership,
there must be the
establishment of clear, measur-able,
accomplishable goals,
objectives, and action steps.
These must be delineated, dele-gated,
and accepted and accom-plished
in order to move toward
resolution of the health prob-lems
facing Arizona's adoles-cents.
* Community includes representatives
from other community residents includ-ing
health care providers, business,
industry and the religious community.
Recommendation #2.. .
THERE SHOULD BE AN
ONGOING, STATE-WIDE
ASSESSMENT OF
ADOLESCENT KNOWLEDGE,
ATTITUDES, BELIEFS, AND
BEHAVIORS
IN CONJUNCTION WITH A
DATA COLLECTION SYSTEM.
Data from this Risk Appraisal
Project provide quantifiable evi-dence
of the need for continued
monitoring of adolescent behav-iors,
as well as more in-depth
assessment of their knowledge,
beliefs, and attitudes about
those behaviors.
Apparent from the presented
data, there is a need to further
adolescents' understanding of
their own behaviors, particularly
those risk-taking behaviors, and
the ultimate consequences of
those behaviors. There is a need
for them to understand their
control in decision making and
how their decisions impact upon
their health, safety, and sur-vival.
There continues to be a need for
more accurate and meaningful
data, particularly in the areas of
unintentional injuries, violence,
substance abuse, mental health
issues, teen pregnancy and sex-ually
active behaviors. However,
the Adolescent Health Risk
Appraisal has provided invalu-able
information, which until its
inception, was unavailable for
the adolescent population across
the state of Arizona.
Recommendation #3.. .
ADOLESCENTS MUST BE
INVOLVED IN THE PLANNING,
IMPLEMENTATION, AND
EVALUATION OF HOLISTIC,
COMPREHENSIVE, AND
SEQUENTIAL EDUCATIONAL
AND SKILL BUILDING PRO-GRAMS
AS WELL AS DIRECT
SERVICES.
At the core of the AHRA Project
was "WIN---WIN---WIN situa-tion
for the student, the school/
district, and the state. From the
adolescents' perspective, they
received pertinent information
about their current health sta-tus
and certain risk behaviors.
In addition, they received sup-portive
information (health mes-sages)
as well as valuable educa-tional
materials (Wellness book-lets,
Fact Sheets, and Resource
Listings).
Throughout the process, howev-er,
the adolescent was reminded
that they were at the center of
their health; they were the deci-sion
makers regarding their own
behaviors; they controlled the
information and the power to
change risky behaviors into
healthy behaviors resulting in
positive health outcomes.
This Project also utilized the
feedback from students to (1)
create Project implementation
policies, (2) produce the Project's
logo, (3) guide health-related
discussions when they arose,
and (4) provide additional infor-mation
that was adapted into
shared materials (i.e. The ADHS
Teen Wellness booklet and Fact
Sheets), Within this framework,
it is recommended that pro-grams
encourage and elicit the
assistance of adolescents during
planning, implementation, and
evaluation of programs for them.
Recommendation #4.. .
THE PARTNERSHIP SHALL
PLAN, IMPLEMENT, AND
EVALUATE COMPREHENSIVE,
CULTURALLY SENSITIVE
SCHOOL- AND COMMUNITY-BASED
PRIMARY (PREVEN-TION),
SECONDARY (INTER-VENTION)
AND TErnIARY
(POST-INTERVENTION)
PROGRAMS, SERVICES, AND
ACTIVITIES IN EACH
SCHOOL and/or COMMUNITY.
The data from the Adolescent
Health Risk Appraisal support
the continuing need for quality
prevention, intervention, and
post-intervention strategies to
address the current adolescent
health issues. However, it is
imperative that these primary,
secondary and tertiary
approaches have several charac-teristics.
First, it is the responsibility of
the Partnership to plan, imple-ment,
and evaluate the interven-tion(~)
i,n order to determine the
effectiveness for their specific
health situation. As evidenced
in the AHRA, schools were able
to identify, through the Post
Data Conference, which areas
where in need of effective pro-gram
planning and implementa-tion.
It was the AHRA which
provided the first set of evidence
(data) to facilitate the need-based
program revisions and
future planning, based on an
assessment specific to that com-munity.
Second, the programs, services,
and activities need to be com-prehensive
in their offerings.
They must look at the adoles-cent
from a holistic perspective
as an active part of a family and
community-based system.
Third, these primary, secondary,
and tertiary strategies must
remain culturally sensitive and
aware of ethnic and racial differ-ences
that exist within the
state's adolescent population.
As the AHRA data suggest, there
were significant differences, not
only in Health Risk Status, but
also in specific areas of behav-ioral
health issues and certain
risk taking behaviors, with
minorities at highest risk in sev-eral
instances.
Fourth, the programs, services,
and activities must be school-and
community-based in order
to meet the needs of those ado-lescents
and their families and
be effective. By being school-and
community-based, these
strategies are made available
and accessible at a much higher
level, As suggested in Healthy
People 2000, the challenge is
for". . .communities to translate
national objectives into State
and local action"(p.7). Creating
such programs, based on needs
assessments and health status
monitoring of the local popula-tion,
is one approach to empow-ering
those who are being appro-priately
served in an effort to
serve them most effectively.
Lastly, the Partnerships that are
established need to provide for
global programs, as well as spe-cific
services and activities.
While the programs are broad-based
in their approach and
scope (see insert), they are not
the complete answer. Additional
services need to be created and
accessed, as well as specific
activities which can be imple-mented.
Nevertheless, pro-grams,
services, and activities
must be provided that are pri-mary
(prevention), secondary
(intervention) and tertiary (post-intervention
in nature.
Recommendations. 5
Recommendation #5. ..
THERE SHALL BE
COLLABORATION BETWEEN
sTATE/COuNTY/CITY/TOWN
OFFICIALS TO PROVIDE
ADEQUATE FUNDING FOR
APPROPRIATE CONSULTATION
AND SUBSEQUENT PLANNING
OF PROGRAMS, SERVICES AND
ACTIVITIES IN EVERY SCHOOL
AND COMMUNITY.
This fifth recommendation is
based on the need for collabora-tion
among all entities identified
on Page 2 of this section.
However, it is vitally important
that government agencies work
collectively with representatives
of a community and community-based
organizations in an effort
to assist them in planning,
implementing and evaluating the
programs, services, and activi-ties
which the community
chooses to support.
In that effort, it important for
governmental agencies to pro-vide
the impetus for such service
delivery changes by offering ade-quate
and sustained funding to
those communities willing to
accept the challenge to improve
the health of their adolescents.
Recommendation #6.. .
PROGRAM EVALUATION WILL
BE INCLUDED IN
THE PLANNING PHASE FOR
ALL PROGRAMS, SERVICES,
AND ACTIVITIES WHICH ARE
CREATED AND THAT
THE EVALUATION PROCESS
WILL BE AN INTEGRAL
COMPONENT TO ANY
PRIMARY, SECONDARY, OR
TERTIARY PROGRAM,
SERVICE, OR ACTMTY.
Based upon Findings from the
Adolescent Health Risk
Appraisal during the three years
that is was implemented, it was
apparent that continuous pro-gram
evaluation would be need-ed
in order to determine the
effectiveness of various actions,
interventions, and programs
that resulted from the AHRA.
Planning for long-term follow-up
of Project participants could pro-vide
useful longitudinal informa-tion
on changes in health sta-tus,
risk taking behaviors, and
general adolescent health.
Furthermore, this document
demonstrates the need for ade-quate
surveillance data and sys-tematic
efforts to collect accu-rate
data on all adolescent
behaviors that effect health sta-tus,
particularly risk behaviors.
Utilizing the AHRA provided only
a minimal needs assessment of
youths around the state.
Because it focused specifically
on 8th and 9th grade students,
there were large cohort groups
(i.e., older adolescents and
dropouts) for whom no data was
collected during the implemen-tation
of this study.
Yet at present, beyond summary
statistics provided by ADHS
Office of Planning and Health
Status Monitoring, the ADE
CAPPE, and ADOT Fatality Data,
there is very limited information
collected and reported on a con-sistent
basis for adolescents
with respect to health. This sit-uation
is further complicated by
the incomparability and incom-patibility
of data types that are
collect by various agencies
based upon different definitions
under which each data set was
created and updated.
Ultimately, program evaluation
must occur for all service deliv-ery
and program implementa-tion.
This is necessary in order
for the various entities involved
with comprehensive adolescent
health in Arizona to be able to
identify effective plans and pro-grams
and to enhance them and
implement them in the most
strategic manner. In addition, it
is stressed that evaluation
must be planned then initiat-ed
at the beginning of program
implementation and conduct-ed
on a consistent basis
throughout the duration of
the project, with follow- up
data being sought on a regular
basis from program partici-pants.
Effective evaluation can
not be an afterthought.
The effectiveness of such com-prehensive
strategies, as pro-posed
within these Recommend-ations,
will be seen'when evalu-ation
is an integral part of every
program, service, or activity.
Recommendations. 6
The Evaluation process and plan
must include:
+ Formative evaluation
(assessment of the formation
of interventions including
documentation of the cre-ation
of infra-structures)
+ Process evaluation
(measurement of actions,
encounters, and degree to
which target populations are
being served)
+ Impact evaluation
(assessment of changes in
knowledge, attitudes, and
behaviors of persons or sys-tems
receiving services)
+ Outcome Evaluation
(measurement of the degree
to which a community or
population's health status
has improved [i. e., morbidity
and mortality statistics,
drop-out rates, shifts in
severity of disease states).
While products of outcome eval-uation
are the ultimate standard
of determining a program's effec-tiveness,
they are long-term
indicators which may be difficult
to collect and relate to specific
program initiatives.
Effectiveness will be achieved
when the emphasis for provision
of services to adolescents and
others is based on service inte-gration
which is culturally sensi-tive,
community-based and
age-appropriate, with adequate
access to those services which
are rendered.
Strategizing To Meet
Healthy People 2000
Objectives
From the description of
Adolescents and Young Adults
in the introduction to Healthy
People 2000:
"The years from 15 to 24 are a
time of changing health haz-ards.
Caught up in change and
experimentation, young people
also develop behaviors that may
become permanent. Attitude
and patterns related to diet,
physical activity, tobacco use,
safety, and sexual behavior may
persist from adolescence into
adulthood.
The dominant preventable
health problems of adolescents
and young adults fall into two
categories: injuries and vio-lence
that kill and disable many
before they reach age 25 and
emerging lifestyles that affect
their health many years later."
(P. 16)
Knowing this information, it is
imperative we remain mindful of
the target areas, many of which
were addressed in the AHRA.
These areas, (with specific
health status, risk reduction,
service and protection objectives
as well as research needs), are
presented in the accompanying
table. They focus on:
d Motor Vehicle Crash
Injuries
d Homicide and Suicide
d Lifelong Health Habits
d Tobacco, Alcohol and
Drugs
d Sexual Behavior.
These target areas are presented
in the Tables found on pages 8
and 9. Below each target area,
facts regarding the associated
behaviors are highlighted.
These are followed by a subset of
specifically selected Healthy
People 2000 Objectives (para-phrased
for brevity) designed to
address those specific areas.
It is understood that there are
identified problems with adoles-cent
health in Arizona, as well
as the Nation. The AHRA has
identified specific behavior risk
areas that challenge us as com-munities,
at large. There is an
awareness that these problems
are multi-faceted and complex.
Through the implementation of
the Recommendations presented
here, in order to strategize to
meet Healthy People 2000 objec-tives,
effective change can occur
for young people, today and
tomorrow. It is by working with-in
our communities, actively
participating in planned
Partnerships, that we will be
able to accomplish goals that
alone any one of the entities
involved in adolescent health
would deem impossible. It is by
working together to meet the
needs of the future that we are
able to better serve our adoles-cent
population with respect to
improving their health, promot-ing
their future development,
and assisting them in their
growth, development, and sur-vival.
Recommendations. 7
Comments
Recommendations. 10
Recommendations. 1 1
Recommendations. 12
As part of our continued commitment to the Evaluation Process and Qudity Improvement, any feed-back
which we receive will be reviewed and assessed. Your comments and suggestions regarding the
content, layout, or presentation of this document are greatly appreciated.
Please return this form to:
Adolescent Health Consultant
Arizona Department of Health Services
Office of Women's and Children's Health
1740 West Adams, Room 200
Phoenix, AZ 85007
Your Comments and Interpretations
Recommendations. 13
Arizona Department of
Education, Comprehensive
Health Unit, Chemical Abuse
Prevention Program. ( 1992a).
Chemical Abuse Prevention
Program Evaluation School
Questionnaire for the 1991 -
92 School Yew.
Arizona Department of
Education, Comprehensive
Health Unit. (1992b).
Chemical Abuse Prevention
Program Evaluation (CAPPE),
Executive Summary, Aqust
1992.
Arizona Department of
Education, Special Programs
Division. ( 1 99 1 a). Model
Policies and Procedures:
Alcohol and Other Drug
Prevention.
Arizona Department of
Education, Comprehensive
Health Unit. (199 lb).
Chemical Abuse Prevention
Program Evaluation (CAPPE),
Executive Summary, January
1991.
Arizona Department of
Education, Comprehensive
Health Unit. (1991~).
Analyses and Summary of
1988-1 990 of the Chemical
Abuse Prevention Program
Evaluation.
Arizona Department of
Health Services, Office of
Women and Children's
Health. (1993). Status of
Adolescent Health in Arizona:
A Report of the Arizona
Adolescent Health Coalition
(Draft).
Arizona Department of
Health Services, Office of
Women and Children's
Health, Arizona Adolescent
Health Coalition (1993).
Meeting Minutes for April 13,
1993.
Arizona Department of
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Health Status and Vital
Statistics 1990.
Arizona Department of
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Planning and Health Status
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Related Mortality, Arizona
1990.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1992~).
Firearm- Related Fatalities,
Arizona 1990.
Arizona Department of
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Planning and Health Status
Monitoring. (1 992d). Injury
Mortality Among Children
and Adolescents, Arizona
1990.
Arizona Department of
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Planning and Health Status
Monitoring. (1992e).
Sexually Transmitted
Disease, Annual Surveillance
Report, Arizona 1992.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (19920. Suicide
Mortality, Arizona 1990.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1 992g).
Teenage Pregnancy, Arizona
1991.
Arizona Department of
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Planning and Health Status
Monitoring. (1992a).
Unintentional Drowning
Deaths, Arizona 1990.
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(1990). Chronic Disease and
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Mortality Weekly Report
(MMWR): 1990 Youth Risk
Behavior Surveillance
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Adolescent Health in
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Implications, and Strategies
for Action.
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Health, Advisory Council on
Adolescent Health. (1992).
Adolescent Health in
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Implications, and Strategies
for Action.
Morrison Institute for Public
Policy (1992). Kids Count
Factbook: Arizona's Children
1992.
National Adolescent Health
Resources Center, University
of Minnesota; Department of
Pediatrics, Medical School.
(1 990). Conducting an
Adolescent Health Survey.
National Adolescent Health
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of Minnesota, Department of
Pediatrics, Medical School.
( 1993). Conducting an
Adolescent Health
Community Needs
Assessment.
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Health, Office of Health
Promotion (1985). Teen
WeUness Check, Version 1.2,
Operator's Manual.
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Public Health Service, Health
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(1993). Report of the
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References. 2
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
1. Are you:
blah ( ) Female ( )
2. Your age is:
13 or under ( ) 14 ( 15 (
16 ( ) 17 ( 18orover ( )
3. What do you consider your racelethnic group to be?
A. White (non hispanic origin) ( 1
6. Black (Afro-American origin) ( 1
C. Hispanic ( )
D. Asian or Pacific Islander ( )
E. Native Am. Indian or Alaskan Native ( )
F. Other ( 1
4. What grade are you in now?
7th ( 8th 0 9th ( 1
10th ( ) 11th ( 1 12th (
5. What is the highest grade you plan to complete?
7th ( 1 8th 0 9th 0 10th ( )
11 th ( ) 12th ( ) College ( )
6. Has a blood relative (parent, grandparent, brother, or
sister) had either a heart attack, a stroke, high blood
pressure, or diabetes before the age 603
A. Yes ( ) B. No ( ) C. Don't know ( )
7. How would you describe your body frame?
A. Largeboned ( ) B. Average ( ) C. Smallboned ( )
8. How tall are you (with shoeslone inch heels)?
A. 4'9 or under ( )
6.4'10"-4'11" ( )
C.5'0"-5'1" ( )
D. 5'2" - 5'3" ( )
E.5'4"-5'5" ( )
F. 5'6" - 5'7" ( )
G.5'8"-5'9" ( )
H. 5'10"-5'11" ( )
1.6'0"-6'1" ( )
J. 6'2" - 6'3" ( )
K. 6'4"- 6'5" ( )
L. 6'6" or over ( )
9. What is your weight? (wearing indoor clothes)
A. 89 lbs or less ( ) B. 90 to 99 ( 1
C.100to109 ( ) D. 110to119 ( )
E. 120 to 129 ( ) F. 130 to 139 ( 1
G. 140 to 149 ( ) H.150to159 ( )
1. 160to169 ( ) J. 170to179 ( 1
K.180to189 ( ) L. 190to199 ( 1
M. 200 to 209 ( ) N.210to219 ( )
0. 220 to 229 ( ) P. 230 Ibs or more ( )
10. How many days in a typical week do you eat breakfast?
A. Every day ( 1 B. 5 or 6 days a week ( )
C. 2 to 4 days a week ( ) D. 1 day or none ( )
11. How many days in a typical week do you eat foods
from each of the four food groups?
The four groups are:
1. Fruits and vegetables 3. milk or milk products
2. breads, grains andlor cereals 4. meat: fish or plant
proteins
I eat something from each of these four food groups ...
A. Every day ( 1
B. 5 or 6 days a week ( )
C. 2 to 4 days a week ( )
D. 1 day or none ( )
12. How often do you snack on foods like pastries,
candy, sweets, soft drinks, or other sugary foods?
A. Daily ( 1
B. At least 3 times a week ( )
C. Seldom ( )
D. Never ( )
13. How often do you brush your teeth?
A. Daily ( ) B. At least 3 times a week ( )
C. Seldom ( ) D. Never ( )
14. How often do you use dental floss on your teeth
and gums?
A. Daily ( ) B. At least 3 times a week ( )
C. Seldom ( ) D. Never ( )
A
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
15. Have you had your teeth checked andlor cleaned at
a dentist's office or clinic in the past 12 months?
yes ( ) No ( 1
16. Have you been immunized (received shots) to protect
you against measles and German measles (rubella)?
A. Yes, both ( ) B. Yes, one ( )
C. Neither ( ) D. I don't know ( )
17. How often do you walk at least one mile without
stopping?
A. Daily ( ) B. At least 3 times a week ( )
C. Seldom ( ) D. Never ( 1
18. Aerobic exercise is any physical activity that greatly
increases both heart rate and breathing. Aerobics
can include exercising, jogging, swimming, jumping
rope, crosscountry skiing, brisk walking, or other
strenuous activities. How often do you get at least
20 minutes of non-stop aerobic exercise?
A. Daily ( ) D. Seldom ( )
B. At least 3 times a week ( ) E. Never ( )
C. Once or twice a week ( )
21. Do you plan on quitting some day?
A. I do not smoke ( )
B. No, I do not plan on quitting ( 1
C. Yes, I plan to quit today or in the very near future ( )
D. Yes, I plan to quit before I get out of high school ( )
E. Yes. I plan quii I 21 Years ( 1
F. I will only quit if forced to by illness or disease ( )
22. Does marijuana smoke contain more cancer causing
agents than tobacco smoke?
Yes ( 1 No ( )
23. In a typical week, what is the most alcohol you drink
in any one day? (A drink of alcohol is either 12 oz.
of beer, a 5 oz. glass of wine, or a 1 1i2 oz. shot of
hard liquor). In a typical week, the most I drink in
any one day is ...
A. None, I do not drink ( )
B. 1 or 2 drinks in one day ( 1
C. 3 or 4 drinks in one day ( 1
D. 5 or 6 drinks in one day ( )
E. 7 or 8 drinks in one day ( )
F. 9 or 10 drinks in one day ( )
G. 11 or more drinks in one day ( )
19. How often do you participate in recreational activities - such as bowling, golf, tennis, basketball, softball,
dancing, or similar activities?
A. Daily ( ) D. Seldom ( )
B. At least 3 times a week ( ) E. Never ( )
C. Once or twice a week ( )
20. How many cigarettes (tobacco) do you smoke or
dips do you use?
A. None, I have never used tobacco ( 1
B. None, I quit ( )
C. A pack or a dip or less per week ( 1
D. More than a pack or dip per week,
but less than one per day ( 1
E. 1 pack or dip per day ( 1
F. 1 to 2 packs or dips per day ( )
G. 2 or more packs or dips per day ( 1
24. Is the abuse of alcohol (a depressant) or any other
drug dangerous?
Yes ( ) No ( 1
25. Do you ever use alcohol with any other drugs?
A. No I don't ( 1
B. Yes, often ( 1
C. Yes, sometimes ( )
D. Yes, but very seldom ( )
26. Do you ever drive under the influence of alcohol or
drugs, or ride with a driver who is?
A. No I don't ( )
B. Yes, often ( )
C. Yes, sometimes ( )
D. Yes, but very seldom ( )
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
27. How often do you use seatbelts when you drive
or ride in a car?
A. Always or nearly always ( ) B. Sometimes ( )
C. Seldom ( ) C. Never ( )
28. When driving a car, do you ever exceed the speed
limit by more than 10 miles per hour?
A. Not driving yet ( 1
B. Never exceed speed limit by 10 mph ( )
C. Rarely exceed speed limit by 10 mph ( )
D. Sometimes exceed speed limit by 10 mph ( 1
E. Often exceed speed limit by 10 mph ( )
29. If you ride a motorcycle, or moped, or bicycle, do
you wear a helmet?
A. Don't ride any of them ( 1
B. Never wear a helmet ( 1
34. Do you know how to swim or stay afloat in water that
is over your head?
Yes ( 1 No ( 1
35. Have you lost more than five pounds in the past few
months without dieting?
Yes ( ) No ( 1
36. Do you usually get enough sl ~ eapn d feel rested in
the morning?
A. Yes, usually ( 1
B. Yes, sometimes ( )
C. No ( )
37. In the past six months, have you had feelings
C. Rarely wear a helmet that life wasn't worth living?
D. Sometimes wear a helmet
E. Always wear a helmet
B. Yes, sometimes
30. When walking or jogging on a road, which side of D. No I haven't
the road do you walk or jog on?
38. Do you have friends or relatives that you can turn to
for help when something is troubling you?
B. Yes, sometimes
39. Can sexual intercourse even once, without effective
B. Yes, sometimes birth control, result in pregnancy?
C. Yes, often or always
32. Do you have a smoke detector in your home or 40. Will sexual activity with several partners increase
a person's chances of getting sexually transmitted
diseases (STD's)? Sexually transmitted diseases
are sometimes called venereal diseases (V.D.)
B. Yes, and I'm sure that it works
C. Yes, but it may not work
D. I don't know
33. Do you ever hitchhike or pick up hitchhikers?
C. Yes, sometimes ( )
D. Yes, but very seldom ( 1
FEMALES
Please Continue (other side)
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
Wellness Check was developed by the Rhode Island Department of Health
FEMALES ONLY SHOULD ANSWER THESE LAST SIX QUESTIONS ...
41. Do you examine your breast each month to
detect lumps?
yes ( No ( 1
42. Has your mother or sister had a breast removed or
an operation on her breast?
A. Yes ( )
B. No (
C. I don't know ( )
43. Has your mother or sister had a hysterectomy
(uterus removed)?
A. Yes ( 1
B. No ( 1
C. I don't know ( )
44. If you've started having menstrual periods, do they
ever last for more than 10 days at a time?
A. I've not not started having periods yet ( 1
B. Yes, my periods have lasted for more than 10 days ( )
C. No, I've not had a period last for more than 10 days ( )
45. Do you know what caused your period to last more
than 10 days?
A. Does not apply ( ) B. Yes ( ) C. No ( )
46. Are women who take birth control pills and smoke
cigarettes at an increased risk of blood clotting?
A. Yes ( ) B. No ( ) C. I don't know ( )
You have completed the Wellness Check risk assessment questionnaire.
Thank You!
TEEN WELLNESS CHECK ADVISORY MESSAGES
Your score on the health risk appraisal is out of 100 points.
Your score places you in the following health risk category:
Excellent (85-1 00)
Fair (70-84)
Risky (55-69)
Hazardous (0-54)
You scored well in the following areas of the questionnaire:
Criieria for printing (S13 means score for question 13). See scored questionnaire.
Diet SlO+Sl1=2
DentalHealth S13+S14+S15=3
Exercise S17+S18+S19=2
Smoking S20 + S21 greater than 1
Alcohol S23 + S25 greater than 0
Auto Safety S26 + S27 + 528 + S29 + 530 + S31 + 532 > 5
Mental Health S35 + S36 + S37 + S38 = 0
You should be proud of the way you take care of yourself in these categories. If you would like information to help
you to maintain or further improve these good health habits, please refer to 'The Way To Wellness For Teens"
booklet you received.
No matter how you answered the questions about drugs and sexuality, everyone is receiving the following mes-sages,
(messages 9,11, 24, 25 and 30 (females only) are printed here.)
(Any of the following messages may be printed. The criteria are listed in the questionnaire given in the
previous section.)
1. * Close relatives of yours have had one or more of the following before age 60:
Heart Attack
Stroke
High Blood Pressure
Diabetes
This family history increases your chances of developing the same condition. Reducing those risk factors
that you can control becomes even more important to you.
2. ' You may be over your ideal weight. You would look and feel better if you ate sensibly and exercised
regularly. Since you may still be growing, don't try to lose weight without consulting a doctor or your
school nurse.
3. ' Try not to skip breakfast, it is the most important meal of the day. Your body needs the energy to get
you through each day.
4. * What you eat definitely effects your health. Try to eat a variety of foods from the four food groups, and
maintain your ideal weight.
5. ' Try to limit sugary foods if you are overweight or if you tend to get cavities.
6. * If you neglect the care of your teeth you are at high risk for tooth decay and gum disease. You should
brush your teeth and use dental floss every day.
7. ' You may not be up to date on your immunizations. This increases your chances of getting measles or
rubella (German measles). Check with your parents, school nurse, family doctor, or local clinic.
* Even though you may play sports or get other forms of exercise, a regular program of aerobic exercise
would be good for your health. To be considered aerobic, the activity you choose must greatly increase
your breathing and heart rate, and continue non-stop for at least 20 minutes, three or more times each
week. Aerobic exercise can include brisk walking, jogging, swimming, cross-country skiing, dancing,
biking, or any other vigorous activity.
Smoking is a major health hazard at any age. It's costly, gives you bad breath;makes your clothes
smell, causes premature wrinkles on your face, and shortens your breath. It is also the major cause of
lung cancer, heart disease, chronic emphysema, and premature death. If you quit now, your body can
return to normal in a very short time.
* Besides marijuana's cancer-causing agents, you should know that marijuana use can affect your think-ing,
memory, concentration; it can lower male hormones in boys and female hormones in girls which
may affect your physical or sexual development; it can also interfere with driving ability and coordination.
* If you continue to drink alcoholic beverages at your present rate you may become an alcoholic even
at your age. You are also more likely to encounter physical and social problems associated with
alcoholism, like trouble relating to people, trouble concentrating in school, and lower resistance to infection.
You should know that alcohol can be a dangerous drug. You should also know that abuse of many kinds
of drugs can lead to permanent physical and mental damage and/or addiction. Overdoses of some
drugs can and do kill. Sniffing or inhaling substances is especially damaging and deadly. Illegal drug
users can never be sure of the 'quality" of drugs they are using. Drug abuse results in loss of self-control.
* Alcohol, when combined with other drugs, can be fatal. Alcohol and barbiturates or tranquilizers taken
together can slow down breathing and heartbeats to the point of death. When alcohol is combined with
stimulants the effects of either drug may be dangerously increased. Combining alcohol and marijuana
can cause more problems than either drug taken alone, especially when driving.
* Alcohol related traffic accidents kill and cripple tens of thousands of innocent people every year. Both
alcohol and drugs greatly reduce reaction time, increasing your chances of causing or being unable to
avoid a serious accident.
" Each year automobile accidents kill and cripple tens of thousands of teens and young adults. It is the
number one cause of death and serious injury for your age group. By wearing seat belts, you greatly
decrease your chances of serious injury or death.
* Speed kills. By driving no faster than the speed limit and driving defensively, your chances of being
involved in an auto accident would be considerably reduced.
* Riding a motorcycle or moped without a helmet places you at increased risk of serious injury or death in
the event of an accident.
* When walking or jogging on a road, you should always walk or jog 30 that you are facing the
oncoming traffic.
When jogging, walking, or riding a bike after dark, always wear light colored clothing, preferably a
reflective vest, or be sure your bike has reflectors. You may see car headlights after dark, but without
reflective clothing, the driver may not be able to see you.
* Hitchhiking is a dangerous practice that can result in kidnapping, injury, rape, and even murder. Picking
up hitchhikers places you at the same risks.
21. * If you spend time in or near the water, you should learn how to swim or stay afloat. Otherwise, you
should wear an approved personal floatation device.
22. An unintentional loss of weight or appetite may be caused by stress and anxiety or may be the result of
a physical problem. If you have experienced an unexplained weight loss, you should check with your
school nurse or counselor or family doctor.
23. ' Your own moods and stresses may be endangering your overall health. Prolonged stress is assodated
with illness such as high blood pressure, heart disease, gastric ulcers, alcoholism and mental or emo-tional
illness. Find healthy ways to relax, like exercising. You may need to talk things over with some
one in your family, a close friend, your school counselor, or someone else who is a good listener.
24. * Feeling really down emotionally happens to almost everyone occasionally--but-it can seriously harm
your health. If you find yourself feeling that life isn't worth living, don't do anything hasty. Seek out those
sources of help that are available to you.
25. Sexual intercourse--even once--without effective birth control, can result in pregnancy.
26. A person may have a sexually transmitted disease (STD) and not know it until permanent damage is
done. You should know that persons who are sexually active with different partners should be checked
for sexually transmitted diseases (STD's) frequently so that they can be treated, if necessary.
27. * You are not taking proper precautions against breast cancer. By beginning a habit of breast
self-examination, your risk from this disease would be greatly reduced.
28. * Although breast cancer is extremely rare in women your age, you may be at a greater risk if your
mother or sister had breast cancer. Be sure to get in the habit of breast self-examination.
29. Although cancer of the uterus is extremely rare in women your age, you might be at a greater risk if your
mother or sister had her uterus removed. Be sure to check with your doctor about how often you should
have a Pap test, which detects cancer early while it can be cured.
30. Menstrual periods that last for ten days or more may be a signal of some disorder. See your school
nurse, doctor, or clinic to identify the problem.
31. * You should know that smoking can result in constriction of blood vessels and poor circulation. When
combined with possible clotting effects of the pill, the result can be a stroke. if you are taking the pill, you
have a special reason not to smoke.
32. * Too much weight is a condition that follows teens into adulthood and may result in serious health
problems such as diabetes, chronic high blood pressure, heart disease, strokes, and even sudden death.
Help is available. Speak with your school nurse, family doctor or local clinic to develop a safe and
healthy eating pattern.
33. * You may be under your ideal weight. It is important that you eat enough food to meet your body's high
energy needs. Dieting to maintain your figure or physique can rob your body of nutrients essential to
normal growth.
34. * Properly installed and working smoke detectors in the home can warn your family of a fire while there is
still time to get to safety.
35. * You should floss your teeth daily to protect both your teeth and gums. If you do not floss regularly, you
run the risk of losing of losing your teeth from gum disease in the middle age, even if you have few or
no cavities.
................... ....................................
WELLNESS FOR TEENS
ARIZONA DEPARTMENT OF HEALTH SERVICES
Arizona Department Of Health Services
Division Of Family Health Services
Office Of Women's And Children's Health
1740 West Adams, Phoenix, Arizona 85007
(602) 542-1880
DF:WLTEENBRCHP
7/93 flr
RESOURCES IN ARIZONA FOR TEENS
Diet And Nutrition
Nutrition Services, Arizona Department of Health Services
Dairy Council of Arizona
"WELLNESS FOR TEENS" WAS DEVELOPED TO PRO-VIDE
INFORMATION ON TOPICS PERTAINING TO
HEALTH AND SAFETY. THE INFORMATION IS IN-TENDED
TO HELP INCREASE YOUR AWARENESS OF
THOSE CHOICES YOU MAKE THAT COULD AFFECT
YOUR HEALTH AND WELL-BEING.
ADOLESCENT HEALTH
ADHSIOWCH 7/93
flr
Cooperative Extension: 4H Clubs;
Food & Nutrition Programs
Local County Health Department
Dental And Health
Dental Services, Arizona Department of Health Services
Phvsical Fitness
Local Parks & Recreation Department
Smoking
American Cancer Society
Arizona Lung Pssociation
(See Phone Book for County Office)
(See Phone Book)
(See Phone Book)
Alcohol
National Council On Alcoholism And Drug Dependency 264-6214
Alcoholics Ano~nyrnous (See Local Listing in Phone Book)
Drugs: Substance Abuse
Community Behavioral Health Services, Arizona Department of Health Services 220-6478
Governor's Office of Drug Policy 542-3456
1-800-533-8920
Traffic Safety
Governor's Office of Highway Safety
Stress
Community Behavioral Health Services, Arizona Department of Health Services 220-6478
Local County Health Department (See Phone Book)
Imrnunizatiaq
Disease Controll, Arizona Department of Health Services
Local County Health Department
Sexualitv and Birth Control
Planned Parenthood of Arizona
Local County Health Department
P ~TDes t and Breast Self-examination
~miricanC ancer Society
Heart AttacWStroke
American Heant Association
Diabetes
American Diabetes Association
230-5852
(See Phone Book)
277-7526
(See Phone Book)
GENE=, 'The Public Health Nurse at your local county health department is aware of local
community health resources. Your local Department of Economic Security office also has listings of
community resources. Churches and synagogues are other resources in a community that may provide
assistance. When calling for help, it is not always necessaly to identify yourself, just ask the question
or briefly state the problem that you wish assistance with.
(The above phone numbers were correct as of December, 1992)
WATER SAFETY
are fun activities which can be done all year in
Arizona. Swimming is one of the best forms of exercise because it does not put
extra pressure on joints and spine. When you are around water, there are certain
things to remember to make sure that your fun does not turn into disaster.
Always swim with a "buddy". That way someone will know if you run
into a problem.
Don't drink alcohol or use other drugs. Alcohol and other drugs slow
your judgement and reaction time.
Don't swim when you're overtired or feeling chilled. Your muscles may
cramp, preventing you from reaching the shore or edge of the pool.
Diving injuries can be very serious. Almost 1,000 people every year become
paralyzed when they injure their spinal cord while diving. Most diving injuries
can be prevented by following these rules:
Always know the depth of the water. Depth can vary at different areas
of the same lake, pond, or river.
e Always jump feet fust on your fust plunge even if you think it's safe to
dive.
Be sure there are no submerged objects, like rocks, in your path. Plan
your path before diving.
When you Do Dive:
Keep your arms extended along the side of your head, in the direction
of the line of flight, with hands together, palms down and thumbs
touching, to cut the impact of the water on the top of the head and to
protect you from injury.
Don't dive into less than 5 feet of water, or into the shallow end of a pool.
Remember when you are boating you use the same skills as driving a car.
Therefore, follow these rules:
Be careful to avoid collisions with other boats: don't "play chicken".
Be aware of swimmers, skiers or people using jetskis in your area.
There are no traffic lights or crosswalks in lakes!
Teen= drowning injuries are often (75% of the time) a result of using alcohol
Dr other druvs. Alcohol and other drugs slow your
minin vour abilities, the pagage of time, or your
surroundings is decreased, making you take chances
which could result in permanent physical dam=.
Making mistakes is human; but don't make a mistake
that you can avoid easily by not mixing drugs and
water sports.
SAY WHAT YOU WANT TO SAY
There are some people who want to say "NO", but say "YES" instead.
Do you find it hard sometimes to stand up for what you believe in or for your
rights? If yes, why? Maybe:
You are afraid of not being accepted.
You are afraid of being embarassed.
You are afraid your friends won't like you anymore.
You don't think anyone listens.
You don't believe you are important.
You are important and you have the right to say and do what you feel is best for
you.
The following are some ideas you may find helpful if you find yourself saying
"YES" when you really mean "NO":
Standing up for yourself in a healthy way
1. Say clearly what it is you really want, or how you feel. Use sentences that
begin with "I". For example: "I am angry that you lost my tape. I would like
you to replace it."
2. Say why you feel this way.
3. Tell the other person that you understand their feelings, and ask if they
would try to understand yours.
When you are feeling under pressure:
1. Delay making a decision. Sometimes a little space and time is helpful when
dealing with a difficult situation. This will give you some time to think about
how you can deal with the person or situation more directly the next time.
2. Talk it over with a friend. You may not be the only one who feels the way
you do.
3. If you think your friendship is on the line, ask: "Do I have to do this to be
your friend?" A person isn't really a friend if he or she tries to pressure you
to do what you don't want to do. You deserve better!
HOW YOU FEEL ABOUT YOURSELF THE SUN RAYS AND YOU
Self-esteem is how you feel about yourself. If you have high self-esteem you will What's Healthy:
tend to feel good about and believe in yourself and feel that you are important. Sunlight, in small amounts on the skin, help produce vitamin D, which is important
If you have low self-esteem you will tend to feel negative about yourself and feel for building strong bones.
unimportant.
Your attitude about yourself will also affect your behavior. You tend to act like What's Not Healthy:
the person you believe yourself to be. Too much sunlight when you're young can cause wrinkles and skin cancer later in
I:$-
It's common for teenagers to have doubts about themselves, and to not like
themselves sometimes. This is a part of growing up. There are a variety of things
you can do to help yourself through the doubtful times or to help improve your
self-esteem. The following are some ideas that may be helpful.
1. Think of at least three of your best qualities. Remember, there are other
qualities besides being athletic, popular or making good grades. Do the
words kind, helpful, loving, responsible or good listener describe you?
Remind yourself of your qualities whenever you feel down on yourself.
2. It's okay if you fmd yourself comparing yourself to others from time to time;
most people tend to do that. It's a way to learn and think about the kind of
person you want to be or don't want to be. Keep in mind, there's a good
chance that you'll find someone smarter, faster or more talented than you in
some things because there are very few people that can be the best at
everything. The most important thing is to be the best that YOU can be.
3. Think of the quality you like least about yourself and make a plan to improve
it.
4. Try not to generalize. Just because you had a fight with your parents, or failed
your math test, doesn't mean you're a bad person or dumb. It means that
ups and downs will occur in your life. The important thing is to try to work
through the ups and downs, resolve them and learn from them.
5. Sometimes it's easy to get down on yourself, remembering only the negative
things and forgetting the positive. Practice telling yourself good things like:
"I'm okay".
"I may not be perfect".
"I sure do have potential".
e "If I really work at it, I can be who I want to be".
You Should Know:
The sun is strongest between 10 A.M. and 3 P.M. Everyone should be
aware of the amount of time spent in the sun. Persons with light-colored
skin and hair, redheads, and anyone with a family history of skin cancer
need to pay special attention to the amount of time in the sun.
Skin cancer is a major problem in the Arizona desert because the sun's
rays are so intense.
Skin cancer is the most curable of all cancers if found early.
Here Are Things That YOU CAN DO To Protect YourselE
1. Avoid sunburn by covering up in bright sun by wearipg a shirt and hat when
outdoors playing, working or enjoying water sports. Don't be fooled by a
cloudy day,, ultraviolet rays can pass through clouds and cause sunburn as well.
2. Apply sun.w, reen. CNPR TE -
TIVE FACTOR. There are different strengths of SPF, each giving different
protection in the sun. The smaller the SPF number the less the protection;
the larger the SPF number increases the protection. To figure out the time of
protection, multiply the minutes you normallv start to burn in the sun without
any protection by the sunscreen SPF number. For example: If you normally
burn in the sun in 10 minutes without protection, a sunscreen with SPF #4
gives 10x4 = 40 minutes of sun protection. Reapply sunscreens frequently
due to sweating, swimming and/or wind. A waterproof sunscreen is a good
idea, but it too will need to be reapplied. The University of Arizona Cancer
Center rec~ommendasn y sunscreen with an SPF #15 or more. There are many
different types of sunscreen that you can buy, so talk with your doctor or
pharmacist to find out which is the right one for you.
3. Apply sunsicreesn 30 minutes before going out into the sun.
4. Don't stay out in the sun too long.
5. Consult your doctor or pharmacist before going out in the sun if you are taking
medication. There are some medications that don't react well with sun.
6. You should know your own skin moles and freckles; see a doctor if you develop
new ones or if they change in shape, size or color.
QUITTING CIGARE'ITES OR SMOKELESS TOBACCO
If you're a user and want to stop, here are some tips that may help:
Think about all the reasons why you want to quit; write some of them
down to remind yourself in case you become tempted.
Giving up a habit is not easy, so be kind to yourself. It will take time. If
you find yourself becoming irritable, take a few minutes to relax and
collect yourself.
BEFORE YOU QUIT:
Change to a brand you don't like.
Postpone your first cigarette or chew of the day by one hour for a few
days, then by two hours, then three, etc.
Set a date for quitting.
WHEN YOU QUIT:
Get rid of all of your tobacco.
Tell everyone you know you're quitting.
Have sugarless gum available for when you have the urge to chew.
Save the money you would have spent on tobacco and treat yourself to
something you wouldn't usually buy.
WHEN YOU HAVE THE URGE TO USE TOBACCO DO ONE OF THESE
THINGS INSTEAD:
Take a walk or exercicse with a friend.
Drink a glass of water or snack on some fruit.
IF YOU FEEL THAT YOU NEED MORE ASSISTANCE IN QUITTING.
Talk with your doctor or dentist.
Call the American Cancer Society at 1-800-227-2345.
Call the Arizona Lung Association at (602) 458-7505.
AIVER YOU HAVE QUIT:
Don't worry if you are sleepier or more irritable than usual; these
symptoms should go away.
When you're in a tense situation try to keep busy. Tell yourself that
smoking or chewing won't solve the problem.
Don't give up. YOU ARE WORTH IT!!!
HELPING SOMEONE QUIT
Being supportive of someone trying to give up tobacco is the best thing you can
do. Let the person know that you care and will help if he or she needs it. Try to
reduce stress factors that will add to the already stressful situation your friend or
family member may be experiencing.
BREAKFAST IS SMART
Breakfast Gives You Energy To:
BeSmart. Be Stronger.
Look and Feel Gdod. Be Active.
Learn More Easily. Think Better.
Usually it is about twelve hours between your evening meal and breakfast. If you
skip breakfast, your body goes sixteen hours without rebuilding your energy
supply for a new day. Energy comes from the foods you eat. Energy helps you
and your body to function and stay healthy. Start your day off right, EAT
BREAKFAST. BREAKFAST IS IMPORTANT!
BREAKFAST IS FAST
"Not enought time" is why many students say they don't eat breakfast. Breakfast
doesn't have to take long. Try these:
Minutes To Prepare:
cereal; milk; juice
toast with peanut butter or cheese; milk; fruit
frozen waffles; pancakes; milk; juice
quick-cooking hot cereal (takes 1-2 minutes) (add raisins if you like)
warm up leftovers from dinner
cottage cheese; toast; juice
egg; toast; muffin; milk; juice
Food For Thou~htI.f you go to bed earlier and get up earlier, you may find you'll
have the extra time you need to eat breakfast.
BREAKFAST CAN TRAVEL
If you can't eat when you get up, take breakfast with you to eat a little later. (Note
"For Safety" at bottom of page.) Try these:
fruited yogurt; graham crackers; juice
fresh fruit; peanut butter sandwich; milk
English muffin (peanut butter, cheese, etc.); juice
hard-cooked egg; whole grain bread; fruit or juice (cook several eggs
ahead, keep up to a week in the refrigerator)
muffin; fruit; milk
leftover meat sandwich (made the night before) and fruit
lunchables
FOR SAFETY: MAKE SURE TO KEEP COLD FOODS (LIKE MILK,
YOGURT, MEATS) COLD AND KEEP HOT FOODS HOT. DO NOT LEAVE
THESE FOODS AT ROOM TEMPERATURE FOR MORE THAN TWQ
HOURS. (THINK ABOUT USING ATHERMOS FOR HOT FOODS AND AN
INSULATED BAG WITH AN ICE PACK FOR COLD FOODS).
DENTAL WISE
Taking care of your teeth now can be a wise move on your part. Here's why:
Your teeth are meant to last a lifetime. If you lose your teeth at a young
age, it affect how you look.
Plaque is a sticky, colorless film of bacteria that forms on the teeth every day. If
plaque is not removed daily, the bacteria breaks down and forms lactic acid that
irritates the gums, making them swollen, tender and likely to bleed as well as
help cause teeth to decay.
Here's What You Can Do:
1. See your dentist for regular check-up visits, at least once a year.
2. Brush and Floss&&! This will keep your teeth and gums healthy. You
will have fresh smelling breath and a nice smile.
DENTAL NEWS FLASH - - - - SEALANTS
Most tooth decay in adolescents takes place on the chewing surfaces of molars.
Decay happens because these surfaces contain pits and grooves. Your dentist
can apply DENTAL SEALANTS, which flow into and coat the pits and grooves
so that bacteria cannot multiply and cause decay.
Sealants: Can last as long as five years.
Drilling is not needed.
Could be checked during regular dental vists.
Can be easily replaced if necessary.
SMOKLESS TOBACCO
You may know smokeless tobacco as chewing tobacco or snuff. Some kids use it
because they think it looks cool or their friends, coach, or relatives use it.
Smokeless tobacco is not a safe choice to make in place of smoking. Smokeless
tobacco contains things that are harmful to your body like: sweeteners, nicotine,
salts and carcinogens (substances that causes cancer).
Chewing (placimg a wad of chewing tobacco between the cheek and the teeth and
sucking on it) or dipping (placing a pinch of tobacco called snuff between the lower
lips and teeth) smokeless tobacco causes:
mouth sores
injury to the gum tissue that hold the teeth
white hard patches where the tobacco is held in the mouth
0 bad breath
staining of the teeth
If you use smokelss tobacco for a long time, cancer of the mouth can appear inside
the lip, tongue, palate or cheek.
Care enough about yourself to say "NO" to smokelss tobacco. It's not always easy
to say "NO" but only you can decide what is best for you.
WELLNESS FOR TEENS
TEENAGE DEPRESSION AND SUICIDE
FACT SHEET
Sometimes a person may feel overwhelmed by problems and pressures and feel helpless and hopeless that things will never get
better. This person may become depressed, even suicidal. Knowing the warning signs of depression and suicidal behaviors could
help you or someone else you care about.
WHAT TO LOOK FOR - - - WARNING SIGNS:
Behaviors:
Some of the following behaviors alone and for short periods of time can be normal behaviors that anyone may experience. However,
if someone is experiencing several of them and they are lasting for more than a few weeks, then this could be a warning sign that a
serious problem exists. Warning signs can vary and can include the following:
w Eating and sleeping problems.
n Withdrawing from friends, family and activities.
>> Excessive substance uselabuse.
>> Major or very noticeable change in appearance.
>> Poor concentration andlor concentrates only a problem.
w Mood changes.
>> Risk taking behaviors.
D Unpredictable outbursts of violence or crying.
The following behaviors are serious warning signs that someone may be in crisis:
P Suicidal remarks; gesters or attempts.
>> Preoccupation with death or suicide.
B Giving away possessions.
>> Giving direct and indirect messages that no one cares about them and their life isn't worth living; there is no hope.
>> Sudden forced cheerfulness after a period of depression.
Recent Stressful Sitnations:
When someone experiences a loss or failure, he or she may feel helpless and hopeless, that things will not get better, and that life
has no meaning. If a change in behavior is noticeable and one or more of the following has occurred, this could be a warning sign
that a problem exists. The most common stressful situations include the following: '
w Divorce of parents.
n Loss of a close friend either through death or moving away.
w Death of someone close.
>> Breaking up with boyfriendtgirlfriend.
>> School problems - failing grades or not getting along with a teacher or other schoolmates.
m Trouble with the law.
m Moving to a new school or town.
> Loss of self-esteem.
w Change in body image - injury or physical illness.
> Sexual or physical abuse.
rn Increased fighting with parents andlor brothers and sisters.
> Change in parents' financial status.
% Z P W s X,- ---
$!IX~A$ i?* .
"CxR b !* :$ :' 3F* ,!*P'li [1,'6/ %:F )i;f4%,!,9
>> 5Shoi.- 1 t (;.B ,IY~ 'ref lak per -Qi truitvfi ,; ar f e , 1 : ~ ,vy;. i n:;3n~t a i d that >nur n e iki :nc fcr t hcm. Iracluaie
acbviiics; do ih,inps f hey Iikr to do. BC 14 pa:.
Listen - giae the person your undivided attsntion and the time "hey need to talk about what is bothering them.
D Respect Their Feelings - don't make light of their problem. The situation may not seem serious to you but it is to them and
that's what counts.
)) Involve A Trusted Adult - encourage the person to talk with an adult they trust. Offer to go with them.
w Take Warning Signs And Threats Of Suicide Seriously - insist on getting help. A suicidal person needs professional help.
Don't try to do it alone. If the person will not talk with an adult who can get the help that is needed, then you do it for them.
Offer to go with them.
)) Do Not Leave A Suicidal Person Alone - if you believe the risk for suicide is immediate.
>) Be Direct - ask the person if they have been thinking about suicide. (Askin? about suicide will not suggest the idea of suicide
or encourape someone to follow through with anv attempts. When vou ask directlvvou are checking things out and letting
)) Do Not Promise To Keep Secrets - never agree to keep the person's thought of or threats of suicide a secret. This secret
could mean the life of that person.
>) Safe Environment - secure or remove dangerous items, such as guns and medications.
n Being Caring And Supportive - of a friend or family member is important all the time, but it's especially important when
that person may be depressed. You can help them get the help they need from an adult they trust and/or from professional
people that are trained. Remember however, you cannot solve their ~roblernsfo r them, and you are not responsible for
their behavicrs.
FOR YOURSELF:
,, It's okay "r ask fo: help when ptoblen~sp, aCSc3TCS or 5:ress seems more than you can handle by yourself. It's not a sign of
failure or vcaknesc bcoause you ask f o r help.
)) Your feelings and pt oblems are i~?;pcrtn nt to 5 ou and that's what counts. Try not to think that they may seem stupid or silly
to others and, therefore, no one will understand or listen.
>) If someone should happen to make light of your problem, don't let that stop you from asking for help. Remember: You Are
Arizona Department of Health Srvices
Family Health Services
Office of Women's and Children's Health Services
1740 West Adams, Phoenix, Arizona 85007
AIDS
FACT SHEET
IT DOESN'T MATIlER WHO YOU ARE, IT'S WHAT YOU DO THAT WILL PUT YOU AT RISK OF GE'ITING AIDS.
AIDS stands for: Acquired Immune Deficiency Syndrome, which is a disease caused by a virus known as HIV (Human Im-munodeficiency
Yirus).
How The HIV Effects The Body;
The Helper T-Cell is a type of white blood cell (which is part of our immune system) that helps to fight off organisms that cause
infection and disease. The HIV attaches itself to, invades and attacks the Helper T-Cells. The HIV reproduces itself, thereby
destroying the T-Cell. When the T-Cell is destroyed, the immune system can no longer attack and destroy organisms. As a result,
a person no longer has the resistance to life-threatening infections.
AIDS. It may take many years between being infected and the development of AIDS. Only a doctor can diagnose AIDS when signs
of infection occur. Some people may be infected with the AIDS virus and not know it until symptoms develop. Persons with the
virus can transmit it to others even if symptoms do not develop.
Local health departments provide confidential testing to all persons, including teenagers, at AIDS counseling and testing sites.
More information about AIDS can be obtained from local health departments, doctors, STD (Sexually Transmitted Disease) clinics,
or the state health department at (602) 230-5819. There is an AIDS National Hotline at 1-800-342-AIDS and an Arizona Hotline
at 1-800-334-1540, during the hours of 8 A.M. - 5 P. M.
How The HIV Is Transmittea
AIDS is a blood borne, sexually transmitted disease (STD). It is transmitted by:
w Sexual contact through vaginal secretions and semen.
There is no danger in donating blood, and the blood test available today makes it rare to receive contaminated blood.
The HIV JS NOT Transmitted By:
Casual contact, such as handshakes or touch.
w Hugs or kisses.
n Objects such as toilet seats, door knobs, showers, bathtubs or drinking fountains.
w Coughing or sneezing. Being around people who have HIV infections1AIDS.
n Insect bites.
n Saliva, tears, urine, feces, sweat. (Unless bloody).
Who Can Get AIDS;
Anyone who engages in unprotected sexual behaviors or risky drug-abusing behaviors with an infected person can get the AIDS
virus. Persons with the following behaviors are more likely to be exposed to the AIDS virus:
) Persons who use needles andlor syringes that may have been used by someone else. (This someone else may be infected
with the AIDS virus and not know it!!!).
Persons who have unprotected anallvaginal intercourseloral sex with a male or female partner.
)) Sex partners of persons with HIV infectionIAIDS.
N Sex partners of persons who have high risk behaviors.
D Persons who received contaminated blood or blood clotting factors between the years 1978 and 1985.
n Newborns who acquire the virus from an infected mother during pregnancy or childbirth (rarely through breast milk).
Prevention of AIDS:
AIDS is not curable, but it is reve en table. Persons can reduce their risk of contracting the AIDS virus by:
Not having sex at all.
n Always using a latex condom when having sex (that means any form of sexual intercourse). You may not know your sexual
partners' history and their sexual contacts before you or whether a person is lying about his or her history so always use a
n Not using IV Drugs (if you are using, enroll into a treatment program and get help to stop).
n Not using needles ansd syringes that may have been used by someone else.
Arizona Department of Health Srvices
Family Health Services
Office of Women's and Children's Health Services
1740 West Adams, Phoenix, Arizona 85007
(602) 542-1880
HOW WAS THE AH= PROJECT
IMPLEMENTED?
Pilot Project for
AHRA Refinement
(1988 - 1989)
Pilot testing of the AHRA admin-istration
procedures occurred
during the 1988- 1989 academic
year. The AHRA Project was
piloted at one school near the
end of the 1988-89 academic
school year.
The students at the first two
schools that completed the
AHRA in the 1989-90 academic
year were surveyed for their
ideas and suggestions regarding
health-related topics which they
wanted more information about.
Since the Way to WeUness for
Teens pamphlet did not address
specific Arizona health concerns
(i.e., effects from the sun,
drowning, etc.), the Arizona
Department of Health Services
developed Wellness for Teens to
provide additional information
based on student feedback and
questions. In addition, student
input and discussion also led to
the development of two fact
sheets: Wellness For Teens-
Teenage Depression and Suicide
and Wellness For Teens- AIDS.
As a result of the pilot testing,
several policies and procedures
were implemented for purposes
of the Project's completion.
Methods of AHRA
Project
Administration
(1989 -1991)
Participant Recruitment
The AHRA was exhibited at the
Arizona School Nurses
Association Conference, School
Nurse Supervisor Meetings, and
the Arizona School Health
Association Conference. These
conferences and meetings pro-vided
opportunities to target the
appropriate school personnel
who might be interested in the
project. Informational packets
about the AHRA Project were
available to anyone who was
interested in the administration
of the AHRA at their school.
For conference participants who
took an informational packet, a
sign-up sheet was provided.
They were to leave their name,
their school's name, address
and a contact phone number.
They were informed that they
would be contacted during the
school year as to whether they
were still interested and/or
wanted to coordinate the AHRA
Project at their school. It was
through this type of exposure at
the conferences and also
through "word of mouth" that
schools within the state of
Arizona became informed about
the AHRA and ultimately
became involved in the adminis-tration
of the AHRA Project at
their school.
The AHRA information packets
available at conferences and
upon request from the
Department of Health Services
contained the following informa-tion
(see Appendix D):
* The Adolescent Health Risk
Appraisal Fact Sheet
* ADHS Protocol For School
Selection For The AHRA
* AHRA Project Policies
* Adolescent Health Risk
Appraisal Program Request
Form for 8th and/or 9th
Grades
* Sample Parent Letter
* Copy of The Teen Wellness
Check Questionnaire
* Samples of School Data
Teen Wellness Check
Advisory Messages
* Samples Teen Wellness
Printouts
One "Excellent" Appraisal
One "Risky" Appraisal
* The Rhode Island
Department of Health
booklet The Way to
Wellness for Teens
* The ADHS booklet Wellness
For Teens
* Resources in Arizona For
Teens Phone List
* Wellness For Teens-Teenage
Depression And Suicide
Fact Sheet (optional)
* Wellness For Teens-AIDS
Fact Sheet (optional)
Tickler Filing System
As a means to track AHRA
requests and scheduled schools,
a tickler filing system was uti-lized.
Index cards requiring the
following information were devel-oped:
Appendix E. 1
Pertinent Demographic
Information
School name
School address
School phone number
School district information
Travel directions to the
school
Personnel Information
Name of Principal
Name of the School Nurse or
Ilealth Aid
Names of the identified staff
for referrals
Teacher(s) with participating
8th and 9th graders
MIRA School Project
Coordinator

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Copyright to this resource is held by the creating agency and is provided here for educational purposes only. It may not be downloaded, reproduced or distributed in any format without written permission of the creating agency. Any attempt to circumvent the access controls placed on this file is a violation of United States and international copyright laws, and is subject to criminal prosecution.

Fife Symington, Governor
State of Arizona
Jack Dillenberg, D.D.S., M.P.H., Director
Arizona Department of Health Services
ARIZONA DEPARTMENT OF HEALTH SERVICES
OFFICE OF WOMEN'S AND CHILDREN'S HEALTH
1740 West Adams Street
Phoenix, Arizona 85007
6021542 - 1880
Permission to quote from or reproduce materials from this
publication is granted when due acknowledgement is made.
September 1993
OfJie of the Director
1740 W. Adams Street
Phoenix, Arizona 85007
(602)542- 1025
(602)542- 1062 FAX
FIFE SYMINGTON, GOVERNOR
JACK DILLENBERG, D.D.S ., M.P.H.,D IRECTOR
To My Fellow Arizonans and Other Interested Parties:
The Adolescent Health Risk Appraisal Project Report summarizes the results and
recommendations of a three year study. We hope that you find it a valuable resource in your
efforts to develop community programs that address adolescent health issues.
A fundamental function of the Arizona Department of Health Services is to identify health issues
specific to Arizona. The method we selected to identify adolescent health issues was to
implement the Adolescent Health Risk Appraisal (AHRA) Project in schools throughout Arizona.
We used a computerized AHRA developed by the Rhode Island State Health Department and
targeted 8th and 9th graders.
This strategy was selected because it provided a Win - Win - Win situation for all involved.
* The students received personalized positive health messages based on their responses to
the questions, a list of community resources and the message that they could improve
their health by decreasing their risks.
* The schools received the aggregate data for use in program planning and curriculum
development.
* The Department of Health Services received information on adolescent knowledge,
beliefs and behaviors which are essential for surveillance, planning of health services and
prevention programs.
It is always our pleasure to work with you to find new and innovative approaches to ensure that
Arizona adolescents are able to grow and become healthy, productive adults.
Dillenberg, D.P.s., M.P.H.
-Leadership for a Healthy Arizona -
When reviewing this Final Report of the Adolescent Health Risk Appraisal Project, it is important
to keep in mind that the findings are representations of 8th and 9th grade students from across
the State of Arizona. This document is a compilation of their self-reported responses to the
Wellness for Teens Questionnaire. As self-reported information, there is an awareness that some
responses may not be as reliable as direct observation. However, what is more critical is that
these self-reported responses represent what the adolescent population feels and reports as being
true, for them. For this purpose alone, it is a valuable contribution to our understanding about
adolescents in Arizona. Without their willingness to respond, the information presented here
would not be available.
The Arizona Department of Health Services, Office of Women's and Children's Health gratefully
acknowledges the many contributions and support received from:
School Administrators, Counselors, Nurses, Teachers, Parents and Students, and
Community Agency Staff who participated in the Adolescent Health Risk Appraisal
The Rhode Island Health Department for providing the Risk Appraisal Program and valu-able
consultation and technical assistance;
The Consultants and Support Staff from The Office of Women's and Children's Health;
Joanne Gersten,Ph.D. from the Office of Planning and Evaluation; the staff from the
Arizona Department of Health Services Offices of Administrative Support, Health
Education, Nutrition, Dental Health, HIV/AIDS, and Chronic Disease Epidemiology; and
the staff from the Comprehensive Health Unit of the Arizona Department of Education.
Special recognition goes to Mark Newall, a South Mountain High School 9th grade student
who won the Adolescent Health Logo Design Contest.
Very special acknowledgement to Susan Wolf, Ph.D. whose patience, persistence, and expertise
contributed to the existence of this document.
It is hoped that the reader of this document will use the information to contribute to the improved
health status of Arizona's Adolescents.
Funding for The Adolescent Health Risk Appraisal Project and Final Report were provided through the Arizona Department of
Health Services, Office of Women's and Children's Health from Maternal and Child Health Block Grant Funds.
Document Creation, Page Layout and Graphic Design by Wattle & Daub Consulting, Tempe, Arizona.
All materials presented within this report are available through the Arizona Department of Health Services, OEce of Women
and Children's Health, 1740 W. Adams, Room 200, Phoenix, AZ 85007.
The Arizona Department of Health Services is pleased to present The Final Report of the Adolescent
Health Risk Appraisal Project (AHRA). It's purpose is to provide invaluable information to all who
have an interest in Adolescents and their health. The Project was created with four goals:
1. To gather information necessary to guide the improvement of health status and quality of ado-lescent
life in Arizona by assessing their current health status and risk taking behaviors;
2. To determine what areas can be sgn&cantly impacted by knowledge of adolescent health status;
3. To analyze the existing data in order to provide recommendations to persons, systems, and
communities for improving adolescent health; and
4. To determine the risk areas which need prioritized attention in conjunction with innovative
strategies to meet the Healthy People 2000 Objectives for Arizona's adolescents and young adults.
This report is divided into five sections: Introduction, Findings, Outcomes, Recommendations, and
References. A detailed description of the Implementation Methods is provided in Appendix E.
Significant findings suggest that adolescents, experiencing constant changes to physical, emotional,
intellectual, and social selves, are developing health habits and behaviors which place them at higher
risk for future health problems, including a shortened life span. Areas of greatest concentration in
the Risk Appraisal focused on:
d Diet and Nutrition d Dental Health d Immunization Status
d Physical Fitness d Smoking d Stress
d Family History of Disease d Alcohol and Other Drugs d Sexuality
d Traffic Safety including: d Cancer Screening For Females
Seat belts Use and Speeding
Helmet Safety
Hitchhiking Behaviors
The overall health status of adolescents, based upon the AHRA data, suggest that there are signifi-cant
differences among the various ethnic groups represented within the Appraisal Project (i.e.,
Anglos, Blacks, Hispanics, Native Americans, Asian/Pacific Islanders and Others). Furthermore,
there were significant differences found between the genders on several issues (e.g., physical fitness,
dental health, traffic safety, and alcohol an other drug use). Details of these highlights are captured
in a Summarized Highlights section at the end of the Findings section. Specific details for each of the
above-mentioned areas are presented in the Findings section.
Outcomes from the AHRA included immediate interventions for two students who notified the ADHS
Staff that they had experienced suicidal ideation. Also, two-thirds of the participating schools indi-cated
that the AHRA data had assisted them in planing, developing and implementing programs
based on the aggregate data which they received from their students who participated in the Health
Risk Appraisal.
Recommendations:
1. THERE SHOULD BE AN ACTIVE SCHOOL-PARENT-STUDENT-COMMUNITY* PARTNERSHIP IN
EVERY SCHOOL and/or COMMUNITY.
2. THERE SHOULD BE AN ONGOING, STATE-WIDE ASSESSMENT OF ADOLESCENT KNOWLEDGE,
ATTITUDES, BELIEFS, AND BEHAVIORS IN CONJUNCTION WITH A DATA COLLECTION SYSTEM.
3. ADOLESCENTS MUST BE INVOLVED IN THE PLANNING, IMPLEMENTATION, AND EVALUATION
OF HOLISTIC, COMPREHENSIVE, AND SEQUENTIAL EDUCATIONAL AND SKILL BUILDING PRO
GRAMS AS WELL AS DIRECT SERVICES.
4. THE PARTNERSHIP SHALL PLAN, IMPLEMENT, AND EVALUATE COMPREHENSIVE, CULTURALLY
SENSITIVE SCHOOL- AND COMMUNITY-BASED PRIMARY (PREVENTION), SECONDARY (INTER-VENTION)
AND TERTIARY (POST-INTERVENTION) PROGRAMS, SERVICES, AND ACTIVITIES IN
EACH SCHOOL and/or COMMUNITY.
5. THERE SHALL BE COLLABORATION BETWEEN STATE / COUNTY / CITY / TOWN OFFICIALS
TO PROVIDE ADEQUATE FUNDING FOR APPROPRIATE CONSULTATION AND SUBSEQUENT
PLANNING OF PROGRAMS, SERVICES AND ACTIVITIES IN EVERY SCHOOL AND CONQVIUNITY.
6. PROGRAM EVALUATION WILL BE INCLUDED IN THE PLANNING PHASE FOR ALL PROGRAMS,
SERVICES, AND ACTIVITIES WHICH ARE CREATED AND THAT THE EVALUATION PROCESS
WILL BE AN INTEGRAL COMPONENT TO ANY PRIMARY, SECONDARY, OR TERTIARY PRO-GRAM,
SERVICE, OR ACTIVITY.
Given these recommendations, which are based on results from the AHRA and underwritten by initia-tives
within the Arizona Department of Health Services, there are several specific areas that are
addressed with respect to the Healthy People 2000 Objectives. The specific health status, risk reduc-tion,
service and protection objectives as well as research needs are presented which focus on the fol-lowing
areas: Motor Vehicle Crash Injuries, Homicide and Suicide, Lifelong Health Habits, Tobacco,
Alcohol and Drugs, and Sexual Behavior.
* NOTE: Community includes representation from other community residents (e.g., health care providers, business, industry,
and the religious community).
Introduction. 1
WIUkT IS THE ADOLESCENT HEALTH
The Project Purpose
RISK APPRAISAL
The Current State of
Adolescent Health
Those who are concerned with
and about adolescents are well
aware of the multifaceted and
inter-related issues concerning
adolescent health. Not unlike
similar-aged youth from across
our nation, Arizona adolescents
are faced with these same ongo-ing
concerns. They focus on
their transitions in physical,
social, and psychological/emo-tional
development, their expo-sure
to risk-taking situations
and their associated behaviors.
All of these issues collectively
impact upon their current and
future health status, as depicted
in the Figure on page 2.
Understanding this interplay of
issues, events, and behaviors,
research has supported the need
for (1) increased awareness of
current health status, (2) early
identification of teens at risk, (3)
presentation of effective and
non-threatening information
needed to make behavioral
change, and (4) the implementa-tion
of comprehensive preven-tion
and intervention strategies
(e.g., school-based,
community-based) .
Startling facts, based upon 1990
statistics, include:
+ 2 1.5% of Arizona youth
age 12 to 1 7 live in families
below the poverty level
($12,700 per family of four),
+ 14% of Arizona youth (ages
10- 18) are uninsured,
The Arizona Department of
Health Services (ADHS), Office of
Women and Children's Health
(OWCH) was interested in
addressing and understanding
@e health of adolescents in
Arizona since there was a scarci-ty
of available data regarding
adolescent health risks. The
Adolescent Health Risk
Appraisal (AHRA) Project was
developed as a needs assess-ment
to collect data and identify
health risk areas, both in terms
of their severity and prevalence.
Furthermore, implementation of
the Health Risk Appraisal pro-vided
a means to increase the
level of health awareness and
delivery of health education to
students, school administrators
and Project-affiliated staff.
PROJECT?
+ 12% of Arizona's children
had no usual source of
health care,
+ 17% of Arizona's adoles-cents
(ages 13-18) need
mental health services due
to behavioral and/or emo-tional
disturbance,
+ 4982 of Arizona females aged
1 7 or younger became preg-nant
(rates of 63.8/ 1,000
young women ages 15- 17
and 2.1 / 1,000 for those age
1 5 and under),
4 34% of the 1 1,502 cases of
chlamydia (an STD) were
identified in Arizona adoles-cents
aged 15- 19,
+ 47.5 deaths per 100,000
Arizona 15- 19 year olds
occurred due to uninten-tional
injuries,
+ 16.1 suicides per 100,000
Arizona 1 5- 19 year olds
occurred, with Native
Americans experiencing a
40.2 per 100,000 rate, and
+ 10.7 deaths per 100,000
Arizona 15- 19 year olds
occurred due to homicide.
Given this information, it is
apparent that a majority of these
statistics represent preventable
situations. Furthermore,
Arizona adolescents, who consti-tute
14% of the state's popula-tion,
are in great need of contin-uing,
effective, comprehensive
strategies to support their
healthy growth, development
and survival.
Pilot testing of the AHRA Project
procedures occurred during the
1988- 1989 academic school
year. Revision of procedures,
policies, and materials based on
participant feedback occurred
prior to implementation during
the 1989- 1990 year (details in
Appendix A). The most impor-tant
additions to the AHRA
Project were the ADHS-created
Wellness for Teens booklet and
Two Fact Sheets: Wellness for
Teens-Teenage Depression and
Suicide and Wellness for Teens-
AIDS (Appendix B). The booklet
was distributed to each partici-pant
during the Project's imple-mentation,
while the Fact Sheets
were distributed upon request.
The Project generated a 'WN-WIN-
WIN" situation for all
involved. It provided individual
health information to students,
aggregate data for schools and
districts, and surveillance infor-mation
for the State.
Components of the Adolescent Self 0
0
The AHRA Project
Components
The Adolescent Health Risk
Appraisal (AHRA) Project utilized
an individualized, computerized
data analysis program that was
developed by the Rhode Island
Health Department in 1983. The
target population (8th and 9th
grade students) was determined
based upon research which indi-cated
that school dropout was
consistently higher in 10th
through 12th grades. As a
result, it was proposed that a
representative sample of 8th and
9th grade students from across
the state of Arizona be selected
for this project to provide maxi-mum
impact for early awareness
of adolescent health-related
issues and information dissemi-nation.
The program consisted of a 46-
item life style questionnaire
(both males and females
answered the first 40 questions,
with girls completing an addi-tional
6 items (questions num-bered
4 1-46) (see Appendix A).
The questionnaire covered the
following topic areas with
emphasis on the types of behav-iors
which adolescents may have
engaged in on a regular basis:
Diet and Nutrition
Dental Health
Immunization Status
Physical Fitness
Smoking
Alcohol and Other Drug Use
Traffic Safety-including:
Seat belts Use and Speeding
Helmet Safety
Hitchhiking Behaviors
Stress
Sexuality
Family History of Disease
Cancer Screening For Females.
Upon completion of the Teen
Wellness Check Questionnaire,
each student was given his/her
Teen Wellness printout which
provided feedback about individ-ual
responses, including both
general and individualized
health messages (see Appendix
B). In addition, students were
given accompanying resource
materials including two booklets
entitled The Way to Wellness for
Teens, and the ADHS Wellness
for Teens (see Appendix C) and a
list of community resources for
each major area covered in the
Risk Appraisal. School-deter-mined
optional Fact Sheets
(Wellness For Teens-Teenage
Depression And Suicide and
Wellness For Teens-AIDS) were
also distributed as part of the
student information packet
when deemed appropriate (see
Appendix D).
A Post Data Conference was
conducted at the end of each
school's participation as a
means of sharing aggregate data
findings. Those in attendance
often included school
Administrators, various staff
members, and health care pro-
.fessionals. Recommendations
based upon Project findings for
further cumculum, program,
and project development were
discussed with the ADHS staff
person, the AHRA Project staff
person, and others that were in
attendance.
Three months after the AHRA
Project implementation was
completed, the ADHS staff per-son
responsible for the AHRA
Project sent the participating
school personnel a follow-up let-ter
and questionnaire. This fol-low-
up procedure assisted in
identifying any further imple-mentation
of strategies and/or
1develop-
Participating Arizona Counties ment of
programs
and cur-ricula
based
upon the
AHRA
findings
for that
particular
school. A
complete
descrip-tion
of
project
, imple-
I menta-tion
is
located in
Appendix
Demographic
Description of the
Student Sample
The final AHRA data set consist-ed
of questionnaire responses
from 7278 eighth and ninth
grade students representing 47
different schools. Of those 47
schools, seven schools had their
population surveyed during both
the first and second semesters
and 10 of the schools requested
the AHRA for two consecutive
school years. These 47 school
were located across the state
with 1 1 of 15 counties being
represented (see State Map
inset).
Ten of the 47 schools did not
meet the policy minimum of
50% of grade level participation
in the AHRA. However, their
data were retained because of
completion of at least 25% of
those surveyed and the provi-sion
of feedback during the Post
Data Conference. Conversely,
nine of the schools had greater
than 90% participation. One
school, with both 8th and 9th
grades surveyed, had greater
than 90% participation from
both grade levels, indicating a
strong commitment and support
for the AHRA Project.
Demographic information for the
7278 respondents included in
the final reported analysis were
+ 5 1.5% (3750) 8th graders
+ 48.5% (3528) 9th graders
with
+ 50.1% (3647) males
+ 49.9% (363 1) females.
Additional information for the
7278 respondents included an
analysis of the responses to Q5.
When asked what was the high-est
grade that they anticipated
to complete, the respondents
indicated that:
(/ 83.1% wanted to complete
college
(/ 12.1% wanted to complete
high school
(/ 4.8% were not planning on
completing high school.
I I
Educational Aspirations of the Sample
Education Level Frequency Percent Cum Percent
<= 8th GRADE 48 0.6 0.6
9th GRADE 5 1 0.7 1.3
10th GRADE 2 1 0.3 1.6
1 1 th GRADE 233 3.2 4.8
12th GRADE 878 12.1 16.9
COLLEGE 6047 83.1 100.0
Age Distribution of Sample
Years Frequency Percent Cum Percent
13ORUNDER 1758 24.2 24.2
14 2973 40.8 65.0
15 2134 29.3 94.3
16 382 5.2 99.5
17 2 7 0.4 99.9
18 OR ABOVE 4 0.1 100.0
Findings. I
WlMT WERE THE FINDINGS FROM Excellent Health Risk Status
THE AHRA
Major Findings by
Questionnaire Topic
The findings from the AHRA
Project are summarized in the
following section. Overall Health
Risk Status is presented first,
followed by presentation of each
questionnaire item. The individ-ual
questionnaire items are
reviewed in the order of appear-ance
within the questionnaire
(Appendix A) and referenced by
question number. Tables
include the AHRA question and
its basic frequencies, percentage
of responses, cumulative per-centages
and the median and
modal responses for each ques-tion.
Since the first nine ques-tions
addressed various demo-graphic
characteristics of the
respondents and have been
summarized in the previous sec-tion,
they are not repeated here.
In addition to the documenta-tion
of Project Findings provided
in this section, there is a com-plete
summary of the frequency
of responses for each question-naire
item in the Wellness
Check. It is based on the total
sample of 7278 respondents.
The summary is presented in
table form as a reproduction of
original data that was shared in
a Post Data Conference in
Appendix F. Furthermore, the
19 individual risk data elements
which were presented as feed-back
in the Teen Printouts are
reproduced and located in
Appendix G for all 7278 Project
participants.
PROJECT? "Excellent" health status sug-gested
that the student was
making healthy and safe choices
Overall Health Risk in the majority of areas and had
attained a numeric health score
Status
As a result of completing the d Only 29.5% of those adoles-
Adolescent Health Risk cents surveyed received
Appraisal, each student received "Excellent" health status on
a Teen Wellness Printout that the AHRA.
rated their responses and gave
feedback to them about their Fair Health Risk Status
es to the AHRA questions that that the student was making
were weighted for response, healthy and safe choices in
each student received a Health many of the areas, however,
Risk Score. want to look at where healthy
choices were not being made.
Their numeric health score
appear on a Teen Wellness 4 5 1.3% were given "Fair"
printout. They included the health status.
Health Risk categories of
"Excellent", "Fair", "Risky" or
"Hazardous". Examples of each
are presented in Appendix H.
Risky Health Risk Status
"Risky" health status suggested
that the student was making
unsafe and unhealthy choices in
many areas. Furthermore, some
of these choices were in areas
identified by the AHRA computer
program as being particularly
risky to one's health. Their
numeric score ranged from 55 to
69.
(/ 14.6% received a "Risky"
health status.
Hazardous Health Risk Status
"Hazardous" health status sug-gested
that the student was
making unsafe and unhealthy
choices in the majority of areas
and the associated numeric
score was at or below 54.
d 4.6% received a "Hazardous"
rating.
Analyses were completed to
compare overall health status
scores with respect to several
demographic variables, includ-ing
ethnicity, age, and gender.
Results indicated that all demo-graphic
descriptors, with the
exception of gender, produced
significant differences in the
mean level of health status rat-ing.
There were several differences
among comparison groups when
analyzing differences in mean
Health Risk Status Scores on
the AHRA. Most noted, there
were significant differences in
mean scores among different
ethnic groups, with
Asian/Pacific Islanders
@J=80.22), Anglos m=79.04),
and Blacks @J=78.35) adoles-cents
experiencing significantly
higher Health Risk Status rat-
HEALTH RISK CATEGORIES
Score Frequency Percent Cum Percent
EXCELLENT (85- 100) 2 148 29.5 29.5
FAIR (70-84) 373 1 51.3 80,8
RISKY (55-69) 1066 14.6 95.4
HAZARDOUS (0-54) 333 4.6 100.0
Total Sample 7278 100.0 100.0
Median 2.000
Mode 2.000
Ethnic Group Frequency Mean SD I ANGLO 4426 79.04 1 1.27
HISPANIC 1749 74.76 1 1.06
BLACK 403 78.35 9.77
NATIVE AMERICAN 309 7 1.82 13.95
ASIAN / P.I. 131 80.22 10.95
OTHER 260 76.94 12.58
Total Sample 7278 77.61 1 1.52 I "Statistically Significant; E (5,7272) = 54.76; Q < .00001 I
Age Group Frequency Mean SD
13 YEARS OR UNDER 1758 78.95 10.06
14 YEARS 2973 77.60 1 1.44
1 5 YEARS 2134 77.58 1 1.87
16 YEARS 382 72.35 14.10
17 YEARS 27 70.12 1 5 -44
18 YEARS OR OLDER 4 72.50 13.18
Total Sample 7278 77.61 11,52
"Statistically Significant; E (5,7272) = 23.45; Q < .OOOOl
Findings. 2
ings than Hispanic M=74.76)
and Native American (M=7 1.82)
adolescents. In ternls of reported
frequencies by Health Risk
Category, Native American youth
were disproportionately repre-sented
in the "Risky and
"Hazardous" categories.
Analyses were also completed to
determine if their were differ-ences
in Health Status as a
result of age. When the data
were represented as Health Risk
Categories, analyses indicated
that those older adolescents
(25.7%) were almost twice as
likely to be categorized with
"Risky" Health Status as those
who were age-for-grade appro-priate
(14.0%). Furthermore,
older adolescents (12.3%) were
three times as likely as younger
adolescents (4.1%) to be catego-rized
with "Hazardous" Health
Risk Status.
Although not statistically differ-ent
in all categories, it was noted
that there were differences
found with respect to gender.
Males (198) were 50% more like-ly
than females (135) to receive a
"Hazardous" rating, regardless of
Findings. 3
Diet and Nutrition
The Adolescent Health Risk
Appraisal Project gathered base-line
diet and nutrition informa-tion
from questions about eating
patterns among adolescents.
Overall, for breakfast eating
behaviors (Q 10) :
(/ 5 1.2% of adolescents eat
breakfast at least five
days per week
(/ 24.2% of adolescents eat
breakfast at most one
day per week or miss
breakfast completely
d Adolescent females (1 147)
were twice as likely to miss
breakfast regularly when
compared to males (6 12)
d Males were 50% more likely
to eat breakfast regularly
(five or more days/week)
then females
(/ Those with 'Excellent' or
'Fair' Health Risk Status
(2500) were ten times more
likely to eat breakfast every
day than those categorized
with a Health Risk Status of
'Risky' or 'Hazardous' (23 1).
QUESTION 10: How many days in a typical week do you ea
breakfast?
Response Frequency Percent Cum Percent
EVERY DAY 273 1 37.5 37.5
5-6 DAYS / WEEK 990 13.6 54.1
2-4 DAYS / WEEK 1798 24.7 75.8
1 DAY OR NONE 1759 24.2 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1,000
Response Frequency Percent Cum Percent
EVERY DAY 2570 35.3 35.3
5-6 DAYS 1 WEEK 2274 31 -2 66.6
2-4 DAYS / WEEK 2000 27.5 94.0
1 DAY OR NONE 434 6.0 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1.000
Response Frequency Percent Cum Percent
DAILY 3259 44.8 44.8
AT LEAST 3 TIMES / WK 2677 36.8 81 -6
SELDOM 1278 17.6 99.1
NEVER 64 0.9 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1,000
Findings. 4
With respect to daily consump-tion
from the four food groups
(911):
d 86.5% of adolescents eat
from the. four food groups at
least 5 days / week
d 6.0% of adolescents eat
from the four food groups at
most 1 day / week or do not
eat from the four food groups
at all
d There were no significant
gender differences in regu-larly
eating from the four
food groups
d Native American and Black
adolescents were more likely
to not have a balanced diet
than their Hispanic and
Anglo counterparts
d Those with 'Excellent' or
'Fair' Health Risk Status
(2289) were eight times more
likely to eat balanced meals
daily than those categorized
with a Health Risk Status of
'Risky' or 'Hazardous' (28 1).
The AHRA question which
focused on snacking behaviors
(Q12) (e.g., candy, sweets, pas-tries,
soft drinks, and sugary
foods) yielded:
d 44.8% of adolescents were
snacking daily
d 36.8% of adolescents were
snacking at least three
times / week
d Only 18.5% of respondents
snacked seldom (17.6%) or
never (0.9%) snacked
d Anglo adolescents were the
most likely (62.3%) to snack
on sweets on a daily basis.
Dental Health
The Adolescent Health Risk
Appraisal provided some base-line
information on several den-tal
health issues including den-tal
hygiene behaviors (913,
Q14) and utilizing preventative
dental services (Q15). These
patterns were not statistically
significant for differences among
ethnic groups, age, or grade
level. However, there were gen-der
differences in dental hygiene
behaviors
The data indicated that:
d 13.1% of adolescents,
regardless of ethnicity, do
not brush their teeth daily,
with 4.7% of those surveyed
stating that they seldom
(4.0%) or never (0.7%) brush
their teeth
d Males were seven times more
likely to never brush their
teeth on a regular basis
when compared to females
d Only 36.8% of adolescents
dental floss at least three
times per week, indicating
that 39.0% seldom floss
their teeth and 24.1% state
that they never floss
d Males were 50% more likely
to never dental floss when
compared to females.
QUESTION 13: How often do you brush your teeth ?
Response Frequency Percent Cum Percent
DAILY 632 1 86.9 86.9
ATLEAST3TlMESlWK 619 8.5 95.4
SELDOM 290 4.0 99.3
NEVER 48 0.7 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
QUESTION 14 How often do you use dental floss on your teeth
and gums?
Response Frequency Percent Cum Percent
DAl LY 980 13.5 13.5
AT LEAST 3 TIMES / WK 1700 23.4 36.8
SELDOM 284 1 39.0 75.9
NEVER 1757 24.1 100.0
Total 7278 100.0 100.0
Median 3.000
Mode 3.000
Findings. 5
not had their teeth cleaned
or checked in the previous
12 months
t/ The lack of consistent dental
care was greatest for
Hispanic (36.5%), Black
(34.0%) and Native
American (33.0%).
These reported behaviors, in
combination with elevated levels
of both snacking behaviors and
tobacco usage, provide evidence
of the need for access to and uti-lization
of products and services
to promote good dental health.
Response Frequency Percent Cum Percent
YES, BOTH 4126 56.7 56.7
YES, ONE 805 11.1 67.8
NEITHER 227 3.1 70.9
DO NOT KNOW 2120 29.1 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
Immunization Status
The Adolescent Health Risk
Appraisal addressed immuniza-tion
status regarding two dis-eases
(916).T he diseases men-tioned
were measles and
German measles (rubella).
These patterns of responding
were significantly different for
ethnic groups.
Of the adolescents surveyed:
(/ 56.7% responded that they
were immunized for both
measles and German
measles
(/ 1 1.1% responded that they
were immunized for only one
of the diseases
(/ The remaining 32.2% felt
that they were either not
immunized (3.1%) or
were unsure of their immu-nization
status (29.1%).
(/ Those with 'Excellent' or
'Fair' Health Risk Status
(3502) were six times more
likely to be immunized than
those categorized with a
Health Risk Status of
'Risky' or 'Hazardous' (624).
No data was collected on immu-nization
status for tetanus.
Also, there were no questions
related to when the most recent
vaccination(s) or booster(s) had
been received.
I Response Frequency Percent Cum Percent I I
Median 1.000
Findings. 6
Physical Fitness
The Adolescent Health Risk
Appraisal provided needs
assessment information with
respect to adolescent activity
levels and fitness (Q17,Q 18,
Q19) and produced an overall
wellness rating and categoriza-tion
of Health Risk Status.
Patterns of behaviors for differ-ent
between males and females
were noted.
In summary of the Physical
Fitness Questions:
(/ Overall, 55.9% of adoles-cents
walk at least one mile
three times per week without
stopping,
(/ 35.6% seldom walk one mile
and 8.5% do no significant
walking.
(/ 64.5% surveyed do 20 min-utes
of non-stop aerobic
activity at least three times
per week
(/ An additional 18.0% do aer-obic
activity one to two times
per week, while the remain-ing
1 7.5% seldom or never
do aerobic activity
(/ 65.4% participated in recre-ational
activities at least
three times per week
(/ 15.7% do recreational activi-ties
one to two times per
week, while the remaining
18.8% seldom or never do
recreational activities
(/ Males were 50% more likely
to participate in daily recre-ational
and aerobic exercise
than females.
Response Frequency Percent Cum Percent
DAILY 1901 26.1 26.1
AT LEAST 3 TIMES / WK 2167 29.8 55.9
SELDOM 2590 35.6 91 -5
NEVER 620 8.5 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 3.000
Response Frequency Percent Cum Percent
DAILY 281 1 38.6 38.6
AT LEAST 3 TIMES / WK 1885 25.9 64.5
ONCE OR TWICE / WK 1308 18.0 82.5
SELDOM 920 12.6 95.1
NEVER 354 4.9 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 1.000
I Response Frequency Percent Cum Percent I DAILY 3074 42.2 42.2
AT LEAST 3 TIMES / WK 1689 23.2 65.4
ONCE OR TWICE / WK 1146 15,7 81.2
SELDOM 1 064 14.6 95.8
NEVER 305 4.2 100.0
Total 7278 100.0 100.0 I Median 3.000
- Mode 3.000
Findings. 7
Smoking
When adolescents were ques-tioned
about their tobacco con-sumption
(either cigarette smok-ing
or chewing tobacco) (Q20):
d 75.4% stated that they had
never used either tobacco
form
d 13.4% stated that they had
already quit using tobacco
d 8.0% acknowledged using
tobacco (cigarettes or dip)
regularly, but less than one
pack or dip per day
d 1.8% regularly use one pack
or dip per day
d 1.4% regularly use more
than one pack of cigarettes
or one dip per day
d Male adolescents were 33%
more likely to smoke tobacco
or use smokeless tobacco
then females
(/ Anglo and Native American
adolescents were more likely
to use more than 1 pack or
dip/day than their Hispanic
or Black counterparts
When those who used tobacco
were questioned about quitting
(Q2 1) :
d 38.4% were going to quit in
the near future
d 18.9% were going to quit by
the time they finished high
school
d 1 1.2% were going to quit by
the time they were 2 1 years
old
QUESTION 20: How many cigarettes (tobacco) do you smoke ?
Response * Frequency Percent Cum Percent
NONE, NEVER SMOKED 5490 75.4 75.4
NONE, I QUIT 978 13.4 88.9
1 PACK OR LESS / WK 404 5.6 94.4
MORE THAN 1 / WK 174 2.4 96.8
BUT LESS THAN 1 / DAY
1 PACK / DAY 131 1.8 98.6
MORE THAN 1 / DAY 101 1.4 100.0
Total 7278 100.0 100.0
Median 2.000
Mode 3.000 * Includes both cigarettes and dips
QUESTION 21: If you are a cigarette smoker, do you plan on quit-ting
some day ?
Response Frequency Percent Cum Percent
I DO NOT SMOKE 6375 87.6 87.6
NO PLAN TO QUIT 173 2.4 90.0
IN NEAR FUTURE 347 4.8 94.7
BEFORE OUT OF H.S. 171 2,3 97.1
BEFORE TURNING 21 101 1.4 98.5
IF FORCED TO QUIT 11 1 1.5 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1.000
d 19.2% were not going to
quit.
d Adolescent males (172) were
50% more likely not to quit
or to be forced to quit than
female adolescents (1 12)
When these same adolescents
were questioned whether smok-ing
marijuana was more likely to
cause cancer than tobacco
smoking (Q22):
d 37.8% said there was no
relationship between
marijuana and cancer.
d 12.3% would quit only if
they were forced to quit
Findings. 8
(/ 62.29h stated "Yes" to
knowing that there are more
cancer causing agents pre-sent
in marijuana smoke
than tobacco smoke.
young cohort group (median age
= 14). When questioned about
the most alcohol consumed in
any one day in a typical week
(Q23):
Alcohol and Other
Drug Use
The adolescents who responded
to the AHRA indicated a relativc-ly
high usage of alcohol as a
d 85% of adolescents stated
that they do not consume
alcohol
QUESTION 23: In a typical week, what is the most alcohol you
drink in any one day ? (A drink of alcohol is either a 12 oz, beer, a
5 oz, glass of wine, or a 1 1 /2 02, shot of hard liquor). In a typical
week, the most in any one day is ...
d 15% stated that they con-sumed
alcohol on any one day
d Males (74) were four times
more likely to consume 1 1 or
more drinks in one day than
females (19).
In contrast to belief, it was not
those who were older adoles-cents
(older than 16) who con-sumed
high levels of alcohol.
High levels of alcohol consump-tion
occurred equally among all
ages groups surveyed.
Response Frequency Percent Cum Percent
NONE, I DON'T DRINK
1-2 DRINKS / DAY
3-4 DRINKS / DAY
5-6 DRINKS / DAY
7-8 DRINKS / DAY
9-10 DRINKS / DAY
11 OR MORE / DAY
Total
Median 1.000
Mode 1,000
When these same adolescents
were questioned whether alcohol
and other drug abuse were dan-gerous
(Q24):
d 93.3% of those surveyed said
"Yes", while
d 6.7% stated "No" to their
knowledge of the dangerous
Findings. 9
nature of alcohol and drug
abuse.
When alcohol is mixed with
other drugs (Q25), the AHRA
respondents identified that
d 1.5% often mixed drugs and
alcohol
d 1.8% sometimes mixed
drugs and alcohol
d 3.6% seldom mixed drugs
and alcohol
d 82.1%donotinixdrugsand
alcohol.
Alcohol and Driving
When asked if adolescents had
ever driven while under the
influence of alcohol or other
drugs ($326): I
(/ 2.9% admitted to drinking
and driving often, or riding
in a vehicle of a driver often
under the influence of
alcohol or drugs.
(/ 5.9% noted that they some I times drank and drove or
were a passenger with a
driver who'd been drinking
(/ 9.2% stated that they did
drink and drive or were a
passenger, but that it was
seldom in occurrence.
(/ Males (124) were 50% more
likely to drive or be a pas-senger
in a vehicle where the
operator was under the
influence of alcohol and/or
drugs than females (84).
However, the majority of those
adolescents who participated in
the AHRA Project (82.1%) stated
that they did drink and
drive, nor were they ever a pas-senger
in a vehicle under the
control of someone who was
drinking and driving.
Seat belt Use and Speeding
The AHRA questionnaire includ-ed
two questions focused on
traffic safety beyond the issue of
drinking and driving behaviors.
The first question (Q27) asked
how often Lhe adolescent wore a
seat belt when they drove or
rode in a vehicle. Overall. the
results indicated that:
4 55.2% almost always or
always wore seat belts
4 25.5% sometimes wore seat-belts
4 9.3% seldom wore seat belts
(/ 10.0% never wore seat belts.
-, I hour b I 1/ 20.0% often exceeded the
speed limit by 10 miles per
II hour.
Although there were no signifi-cant
difference in traffic safety
behaviors among ethnic groups,
the adolescent males (6.9%)
were five times more likely to
often exceed the speed limit
than females (1.3%).
Findings. 10
The second question (Q28)
asked how often the adolescent
exceeded the speed limit by
naorc than 10 miles/hcur when
jrnijng. Since a majority of stu-d
e ~ t(s7 9.4Oh) in this sample
were not yet driving, the remain-
~xig2 0.6% answered that:
d 34.4% never exceeded the
speed limit by 10 miles/hour
(/ 22.2% rarely exceeded the
speed limit by 10 miles/hour
(/ 23.4% sometimes exceeded
the speed limit by 10 miles/
Response Frequency Percent Cum Percent
NO, I DO NOT 5973 82.1 82.1
YES, OFTEN 208 2.9 84.9
YES, SOMETIMES 427 5.9 90.8
YES, BUT SELDOM 670 9.2 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
0
a
a
a *
0
(I,
a
a*
0
e
e*
0 **
0
0
0 *
(I,
a
*e
m
0
0
*
a
0
*
@
0 *
0
Helmet Safety Pedestrian Behaviors
ed one question (Q29) focused ed two questions about pedestri-an
behaviors. The first question
lescent wore a helmet, the jogging in traffic. When ques-results
indicated that: tioned about direction of walking
in traffic, adolescents indicated
d 39.6% stated that they did
not ride mopeds or motor-cycles
or bicycles d 29.5% walk and/or jog
facing oncoming traffic
d 6.2% almost or always wore
helmets d 30.7% walk/jog in the same
direction as traffic
d 6.3% sometimes wore hel-mets
d 39.8% walk/jog on either
side of the street.
d 5.5% rarely wore helmets
Although these behaviors may
d 42.5% never wore helmets. not seem risky, it must be
remembered that many of the
In general, female adolescents respondents to the AHRA reside
(66.8%). However, females were
50% less likely to even ride on There were no significant differ-
Findings. 1 1
The second question on pedes-trian
behaviors (Q31)a ssessed
the use of reflective clothing
after dark when walkingjogging
or bike riding. When ques-tioned,
adolescents indicated
that:
(/ 16.0% often wore reflective
clothing
(/ 26.7% sometimes wore
reflective clothing
d 29.1% did not wear reflective
clothing after dark
(/ 28.2% did not walk/jog or
bike ride after dark.
There were significant differ-ences
between male and female
adolescents, with females having
indicated that they were two and
one-half times more likely to gmJ
walk, jog, or bike after dark than
male adolescents of the same
age group.
The third question, (Q37),
focused on one aspect of suicide,
that of suicidal ideation. It
asked if the respondent had
experienced any ". ..feelings that
life was not worth living". In
response:
(/ 52.8% had not experienced
feelings that life as not worth
living
(/ Of the 47.2% who had some
feelings that life was not
worth living; 12% responded
often, 2 1.8% responded
sometimes, and 13.5%
responded rarely.
Of those who often or sometimes
have feelings that life is not
worth living, there were signifi-cant
differences among male
and female adolescents. Girls
(1538) were 50% more likely to
experience these feelings com-pared
to boys (9 15).
This pattern was also true for
those who were two or more
years older than their grade
cohort (those 16 years of age or
older). They, too, were 50%
more likely to experience the
feelings that life was not worth
living, when compared to those
age 15 or younger.
The fourth question ($38) refer-enced
the adolescent's availabili-ty
of a "support system" (friends
or family that they can turn to).
In response:
(/ 9 1.4% of adolescents stated
that a support system was
usually available (72.1%) or
sometimes available (19.3%)
(/ 8.6% of surveyed adoles--
cents stated that they have
-no support system available.
Percent Cum Percent
YES, SOMETIMES
Median 4.000
Adolescent males were 50% adolescents (9.2%) who have
Given the previous information,
a more in-depth picture was
achieved by looking at Question
37 and Question 38 simultane-ously.
It is alarming to note
that 324 (4.5%) of the total sam-ple
of 7278 adolescents sur-veyed
had experienced thoughts
that life was not worth living
.either often or sometimes and
these same youth did not have
any support system available to
them. For an additional 665
Findings. 13
Sexuality
The AHRA did not specifically
address the sexual behaviors of
the 8th and 9th graders sur-veyed
during the AHRA Project.
It did, however, address several
issues related to knowledge of
consequences of sexual activity.
The first question (Q39)a sked
the respondent "Can sexual
intercourse, even once, without
effective birth control, result in
pregnancy?" The findings indi-cated
that:
(/ 8 1. .7% responded "Yes"
(/ 5.5% stated "No"
(/ 12.8% were unsure of the
answer.
When analyzed by gender, it was
significant that twice as many
males (267) felt there was no
relationship between one sexual
encounter and the possibility of
pregnancy when compared to
female adolescents ( 134).
Of interest, there were signifi-cant
differences in the number
of adolescents who responded
"No" or were "Unsure" of the
response to the consequences of
unprotected sexual activity.
Native Americans (36%) and
Hispanics (28%) were most likely
to state that pregnancy was not
a consequence of unprotected
sexual activity, or that they were
unsure of the consequences.
When comparing the responses
of those who were unsure, how-ever,
there were no significant
differences between the number
of males (498) and females
(433). There were also no signif-icant
differences in responding
to Question 39 when comparing
Response Frequency Percent Cum Percent
YES 5946 81.7 81.7
NO 40 1 5.5 87.2
NOT SURE 93 1 12.8 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1.000
Response Frequency Percent Cum Percent
YES 6065 83.3 83.3
NO 265 3.6 86.9
NOT SURE 948 13.1 100.0
Total 7278 100.0 100.0
Median 1.000
Mode 1.000
Health Risk Status groupings.
Findings. 14
The second AHRA question
(940) addressed the issue of
multiple sexual partners and the
associated increased risk of con-tracting
sexually transmitted
diseases (STDs) . The results
indicated that:
d 83.3% responded "Yes"
d 3.6% responded "No"
d 13.0% were unsure of the
correct answer.
When analyzed by gender, it was
significant that more than twice
as many males (18 1) felt there
was no relationship between
multiple sexual partners and the
possibility of contracting STDs
when compared to female ado-lescents
(84).
Again, there were significant dif-ferences
in responding when
comparisons were made among
the ethnic groups surveyed.
There were significant differ-ences
in the number of adoles-cents
who responded "No" or
were "Unsure" of their answer to
the consequences of multiple
sexual partners and increased
risk of contracting STDs. Native
Americans (30%), Hispanics
(24%) and Blacks ( 19%) were
most likely to state that STDs
were not a consequence of mul-tiple
sexual partners, or that
they were unsure of the conse-quences.
Female Health
The last six questions of the
AHRA were answered only by
female adolescents, concerning
issues of their own health.
When questioned about their
own breast cancer prevention
behaviors (monthly breast self
exam) (Q4 l), female adolescents
note that:
d only 17.6% conducted
monthly breast self-examinations
d 82.4% not completing
regular, monthly breast
exams.
And this lack of preventive
health behavior was not signifi-cantly
different among ethnic
groups or between grade levels.
However, these same female
adolescents were quite informed
with respect to knowledge of
family history related to breast
cancer (542). Findings indicat-ed
that:
d 89.0% were aware that
there was no breast cancer
in their family
d 5.6% knew that cancer was
present
d 5.4% did not know or were
unsure of their family health
status in relationship to
breast cancer.
Response* Frequency Percent Cum Percent
YES
NO
Total
Median 2.000 * Only female responses
Mode 2.000
Findings. 15
When questioned about their
family histories with respect to
any female members having had
a hysterectomy, these female
adolescents were quite knowl-edgeable
of their family history
(Q43). Findings indicated that:
(/ 70.1 % were aware that
female family member had
had a hysterectomy
(/ 14.9% knew that someone
had had a hysterectomy
(/ 15.0% did not know or were
unsure of their female family
member's health status.
There were no significant differ-ences
found among ethnic
groups or among age groups.
When asked about their own
health and the regularity of their
menstrual cycles (Q44):
(/ 84.1% had not had a period
that lasted more than ten
days
(/ 7.9% had experienced peri-ods
lasting more than 10
days
(/ 8.0% had not started men-struating
yet.
Again there were no significant
differences in responding among
ethnic or age groups.
When questioned further regard-ing
irregular periods, those
experiencing irregular periods
(greater than 10 days in dura-tion)
(Q45) noted that:
(/ 56.8% did not know the
cause or reason for the
extended or irregular men-strual
cycle
DO NOT KNOW
"Only female responses
son(s) for their period lasting
10 or more days. There were several additional
questions that were asked of all
tions focused on other areas not
specifically addressed by topic
among those who smoke ciga-rettes
and use The Pill (Q46),
The results from analysis indi- Family History of Disease
cated that:
The AHRA surveyed adolescents
(/ 35.3% knew about the were somewhat informed with
increased risk
no increased risk of blood
tain what relationship exist- family history of disease
ed.
(/ 24.4% were aware that there
Again, there were no significant were none of the mentioned
differences found among ethnic diseases found in their fam-groups
of female adolescents, or ily or among near relatives.
among age groups.
(/ 32.4% did not know or were
unsure of the family history
for heart attack, stroke, high
blood pressure, or diabetes.
Analysis of the data revealed
that there were no significant
differences between males and
females, or among age groups or
I
Findings. 16
Environmental Safety
The second question asked
respondent if they knew whether
there was a fire detector in their
home or apzirtment and whether
the device was working (Q32).
The results of this question to
assess one aspect of environ-mental
safety and risk reduction
indicated that:
t/ 62.4% had smoke detectors
in their residence and they
knew it to be in working
order,
(/ 15.6% either did not know if
they had an alarm(4.5%)
or knew they had one but
did not know if it was func-tional
(1 1.1%)
t/ 22.1% said there was no fire
detector in their home or
apartment.
The third question assessed the
swimming safety of adolescents
(934) in order to determine one
component of unintentional
injuries. This issue is central to
all children in Arizona as annual
statistic from 1990 data suggest
a rate of 2.7 per 100,000 for
unintentional drownings in ado-lescents
14- 19 years of age.
Although this statistic has been
reduced since 1980 from 7.1, it
is still an alarming and pre-ventable
situation.
AHRA adolescents indicated
that:
t/ 93.8% could swim safely
Response Frequency Percent Cum Percent
YES 3144 43.2 43.2
NO 1779 24,4 67.6
DO NOT KNOW 2355 32.4 100,O
Total 7278 100.0 100.0
Median 1.000
Mode 1,000
QUESTION 39: Do you have a smoke detector In your home or
apartment ?
Response Frequency Percent Cum Percent
NO 1605 22.1 22.1
YES, IT WORKS 454 1 62 -4 84.4
YES, BUT UNSURE IF 807 11.1 95,5
IT WORKS
DO NOT KNOW 325 4.5 100.0
Total 7278 100,O 100,O
Median 2.000
Mode 2.000
QUESTION 34: Do you know how ta swlm or stay afloat In water
hat is OYW your head 3
Response Frequency Percent Cum Percent
YES
NO
Total
Median 1.000
Mode 1,000
t/ 6.2% were unable to swim or
stay afloat in water over
their heads.
Findings. 17
Summarized
Highlights
Based on the findings from the
Adolescent Health Risk
Appraisal, the following summa-ry
of the major findings are pre-sented
here.
+ Less than 30% of the 7278
8th and 9th grade adoles-cents
surveyed received
an Excellent Health Risk
Status rating
+ Five percent received a
"Hazardous" Health Risk
Status rating
+ Anglos, Blacks, and Asian/
P.I. adolescent's self-reported
results indicated that they
were healthier than their
Native American and
Hispanics counterparts
+ Almost 25% of adolescents
Eat breakfast at most one
time per week or miss break-fast
completely, with girls
being twice as likely as boys
to miss breakfast regularly
+ Native Americans and Blacks
were more likely to have
a balanced diet when com-pared
to their Hispanic and
Anglo counterparts
+ 13% of those surveyed do
-not b rush their teeth daily
+ Males have worse dental
hygiene (brushing and
flossing) than females
+ With respect to immuni-zation
for measles and
German measles, only 57%
of adolescents reported being
immunized
+ Approximately 25% of the
adolescents surveyed do not
do physical activity on a reg-ular
basis (less than 3 times
per week for recreational
activities, aerobic exercise,
or walking)
+ Males were 50% more likely
to participate in physical
activities on a regular basis
when compared to similarly
aged females
+ 75% of those surveyed noted
that they had never tried
tobacco (in either form of
cigarettes or smokeless
tobacco (dips))
+ Anglo and Native American
adolescents were more likely
to be heavy tobacco users
then Hispanic or Black
adolescents (more than one
pack or dip per day)
+ 85% of those surveyed had
identified that they do not
consume alcohol on a daily
basis
+ Heavy alcohol consumption
(more than 6 drinks in a day)
was greatest for Native
American adolescents
+ 7% of those surveyed self-reported
that they do mix
drugs with alcohol +
+ 18% noted that they had
engaged in drinking and
driving, or had been a pas-senger
with someone who
had been drinking
+ Almost 20% of those sur-veyed
noted that they seldom
or never wear seat belts
Findings. 18
+ Only 6.2% of adolescents
regularly wear a helmet
while biking or cycling
+ Over 90% of those adoles-cents
surveyed do not hitch-hike
or pick up hitchhikers
1 + 47% of respondents noted
that they had feelings that
life is not worth living
+ 8% of adolescents noted that
they had no support system
available to them
+ Over 18% of adolescents did
not know that sexual inter-course,
even once, without
effective birth control can
result in pregnancy
+ Over 16% were unsure or
disagreed with the statement
that multiple sexual partners
increases the risk of con-tracting
STDs
+ 82% of females did not do
monthly breast self-exam
+ One-third of those surveyed
did not know what their fam-ily
history was for heart
attack, stroke, high blood
pressure, or diabetes
+ Two-thirds of those surveyed
had smoke detectors in their
homes and knew them to be
functioning
+ 6% of the respondents could
not swim or stay afloat in
water over their heads
Based on these findings, it is
imperative to utilize this infor-mation
in an effective manner to
address the health of Arizona's
adolescents. The next section
will address this concern.
+ Three programs (10%) were
expanding their current pro-grams
to include the school
nurse as an informational
resource person who will
actively participate in the
educational component of
their health cumculum.
WHAT WERE THE AHRA PROJECT
OUTCOMES?
+ One school noted that their
next "Retreat Day" was going
to be focused on the issues
and topics raised as a result
of the information from the
AHRA Aggregate Data.
Immediate
Interventions at Time
of AHRA
Implementation
In addition to the continued
support for the Project by
administration and staff within
the schools, their involvement in
the Post Data Conference and
Program Planning, two immedi-ate
outcomes took place as a
result of the AHRA Project.
First, there were a series of "In-class
Discussions" that resulted
from the process. On many
occasions and at different
schools, in response to the ques-tion
about family disease histo-ry,
much discussion evolved and
many questions were generated.
There were specific questions
and particular emphasis on dia-betes,
heart disease, breast can-cer
and high blood pressure.
Second, there was "Immediate
Intervention Counseling" provid-ed
on at least two occasions. As
a result of the AHFU Project, two
students identified themselves to
the ADHS staff person as at risk
due to suicidal ideation and
attempts. Because of the poli-cies
related to crisis interven-tions
and available staff, these
students were referred immedi-ately
to the classroom teacher
who in turn walked each stu-dent
to the counselor's office.
However, follow-up information
was not made available from
these interventions for purposes
of this report.
When asked if there was any
additional information that the
participants felt was missing
from the ADHS Wellness for
Teens booklet, there were five
specific areas that were men-tioned.
Follow-up Contact
Three months after the AHRA
Project had been completed in
any school, a follow-up letter
and questionnaire were sent.
Each of the 47 participating
schools received the follow-up
materials. While 15 schools did
not respond to the follow-up
contact, there were 32 question-naires
that were returned and
the results are presented in the
accompanying Table on page 3.
Of significance, the data indicat-ed
that:
+ All 30 programs indicated
that the materials they had
received through the AHRA
Project (i.e., educational
information and resource
listings) were helpful.
+ 28 of the 30 (93%) schools
requested that the AHFU be
made available and offered
on site in the future, with
one school promoting
district-wide implementa-tion.
+ Six schools were implement-ing
new programs which
included DARE, QUEST,
CHAMPS, a Substance
Abuse Support Group, a
Wellness Program, and
Suicide Crisis Intervention
Program.
First, there was a need for a
Male Section, similar to the last
six questions which comprise
the AHRA, but focused on male
sexuality and health. Second,
there was a request for a section
devoted to problem solving and
decision making. Third, there
was a request for a section
focused on Stress in Teen Life.
The fourth request was for more
information on AIDS, in addition
to the optional Fact Sheet. And
fifth, there were several requests
for information on Sexual
Activity and Sexually
Transmitted Diseases, with an
emphasis on behaviors and their
consequences.
Outcomes. 1
School-based
Curriculum
Development
From information received
through the Follow-Up
Questionnaire, it was identified
that numerous schools had
implemented changes and addi-tions
to their current curriculum
as a result of information
obtained from the AHRA Project.
As noted in the previous Table, a
considerable number of partici-pating
schools had made
changes or were in the process
of making changes to their cur-ricula.
Most notably, curricu-lum
changes included:
+ 63% in Alcohol and Drugs
+ 57% in Nutrition
+ 53% in Depression and
Suicide
+ 43% in Adolescent Sexuality
+ 43% in Stress
+ 43% in Tobacco Usage.
As noted previously, there was a
trend toward addition of specific
health objectives to address
areas which had been highlight-ed
through the AHRA Project
process and Post Data
Conference. These additional
objectives were to be targeted
and taught through already
existing courses and classes
such as physical education, sex
education, and Alternative Skills
classes. However, development
of specific health skills such as
breast self-examination and tes-ticular
examination met with
disapproval from the School
Board at one participating
school.
Furthermore, and most impor-tantly,
there were no statements
from responding schools regard-ing
the development of and
instruction in skills which would
be both comprehensive and inte-grated
throughout the cunicu-lum.
Program Planning and
Development
Although there were 28 schools
(59.6% of all participants) that
identified changes to their cur-ricula
and current programs
within their school, the informa-tion
regarding specific program
development was limited. As a
result of receiving their school's
aggregate AHRA data and
responding to the Follow- Up
Questionnaire, responses indi-cated
that there has been an
increased awareness among
adolescent students regarding
their health issues.
Furthermore, schools have
implemented several
school-based programs. To
date, however, there have been
no Community-based Programs
identified that were implemented
or a currently being implement-ed.
In addition to program planning,
development, and implementa-tion,
the AHRA had another sig-nificant
outcome. Several
responses from the three-month
follow-up letter focused on rhe
usefulness of the AHRA Data for
"bottom- line" issues. Each
respondent wrote an explanation
of how the AHRA data con-tributed
to change in their sys-tem.
Specifically, the Aggregate
Data results from the AHRA
Project were shared with School
Board Members in order to (1)
justify funding for additional
education programs and expan-sion
of current curricula and (2)
to defend current budgets for
existing programs when budget
cuts were eminent. This type of
justification with tangible evi-dence
from the AHRA provided
these schools with the necessary
ammunition (data) for the bud-get
battlefront.
their health, with the adolescent
at the center.
As depicted, these entities must
work, actively, in a coordinated
effort to enhance the current
levels of adolescent health in the
state of Arizona. They must
form partnerships, coalitions,
and alliances to benefit the
youth of Arizona by collectively:
UTHAT ARE THE RECOMMENDA-TIONS
FOR ADOLESCENT HEALTH
BASED UPON THE AHRA PROJECT
+ identifying effective courses
of action to be taken on
global and specific issues
related to adolescent health;
FINDINGS?
Improving Adolescent
Health:
A Comprehensive
Approach
As described in the Introduction
and exemplified in the previous
sections, adolescent health is a
multi-faceted and complex inter-play
of issues, events, and
behaviors. As depicted in the
graphic representation of the
adolescent on page 2 of the
Introduction, the adolescent can
be viewed as a complex system
experiencing continual changes
in their social, emotional, intel-lectual
and physical selves.
Having an awareness and
understanding of these integrat-ed
systems within our youth
demonstrates a need for a com-prehensive
approach to meeting
all their health care needs (i.e.,
medical, behavioral, and dental).
In order to begin to better serve
Arizona's adolescent population
with respect to improving their
health, promoting their future
development, and assisting in
their continued survival, what is
recommended is a broad-based,
culturally-sensitive, comprehen-sive
approach to adolescent
health issues. This comprehen-sive
approach must include the
cooperative efforts of all those
involved with adolescents in
Arizona. The approach must
encompass several influential
entities.
+ locating resources, acquiring
funding, and implementing
programs;
Influential Entities
+ Teens, themselves
+ Family members
+ Educational Institutions
(Schools, Districts, and
The Arizona Department of
Education [ADE])
+ Voluntary Health
Agencies and Service
Organizations
+ Community Groups inter-ested
in Adolescent Health
+ Religious Community
+ Public Agencies
(Departments of Health
Services, Education,
Transportation, Economic
Security, and Governor's
Councils)
+ Health Care Providers
(Primary Care, Specialists,
Dental)
+ The Media
+ The Legislature
+ Private Sector
(Corporations, Small
Businesses, and
Entrepreneurs)
The graphic presented on Page 2
is provided to help visualize this
interplay of the entities involved
in promoting adolescents and
+ evaluating programs on a
consistent and ongoing basis
to determine effectiveness;
and
+ prioritizing adolescents in
the state of Arizona.
The caveat to the following list of
recommendations is that the
model can not dismiss its
responsibility to the total ado-lescent
within his/her environ-ment,
even though a single
problem or situation may be
addressed from within this
framework (e.g., street violence,
suicide, teen pregnancy, alcohol
abuse, nutrition). It is the holis-tic
approach to family systems
that must not be ignored.
Furthermore, the adolescent,
who is central to this model,
must grow in the understanding
that their health is their own
responsibility. It is controlled by
the continued choices that each
individual makes on a daily
basis.
Recommendations. 1
Influential Entities
Recommendations
Recommendation # 1.. .
THERE SHOULD BE AN
ACTIVE
SCHOOL-PAFtENT-STUDENT-
COMMUNITY*
PARTNERSHIP IN EVERY
SCHOOL and/or COMMUNITY.
Since the health of Arizona's
adolescents is everyone's con-cern,
no one agency, system, or
provider can handle the problem
alone. With concerted, coordi-nated
partnerships, committed
to- improving adolescents' health
and well-being, many of these
adolescent health problems can
be resolved.
It requires partnerships, among
all the entities, but particularly
among the adolescent, his/her
family, their school, and their
community. Within this part-nership,
there must be the
establishment of clear, measur-able,
accomplishable goals,
objectives, and action steps.
These must be delineated, dele-gated,
and accepted and accom-plished
in order to move toward
resolution of the health prob-lems
facing Arizona's adoles-cents.
* Community includes representatives
from other community residents includ-ing
health care providers, business,
industry and the religious community.
Recommendation #2.. .
THERE SHOULD BE AN
ONGOING, STATE-WIDE
ASSESSMENT OF
ADOLESCENT KNOWLEDGE,
ATTITUDES, BELIEFS, AND
BEHAVIORS
IN CONJUNCTION WITH A
DATA COLLECTION SYSTEM.
Data from this Risk Appraisal
Project provide quantifiable evi-dence
of the need for continued
monitoring of adolescent behav-iors,
as well as more in-depth
assessment of their knowledge,
beliefs, and attitudes about
those behaviors.
Apparent from the presented
data, there is a need to further
adolescents' understanding of
their own behaviors, particularly
those risk-taking behaviors, and
the ultimate consequences of
those behaviors. There is a need
for them to understand their
control in decision making and
how their decisions impact upon
their health, safety, and sur-vival.
There continues to be a need for
more accurate and meaningful
data, particularly in the areas of
unintentional injuries, violence,
substance abuse, mental health
issues, teen pregnancy and sex-ually
active behaviors. However,
the Adolescent Health Risk
Appraisal has provided invalu-able
information, which until its
inception, was unavailable for
the adolescent population across
the state of Arizona.
Recommendation #3.. .
ADOLESCENTS MUST BE
INVOLVED IN THE PLANNING,
IMPLEMENTATION, AND
EVALUATION OF HOLISTIC,
COMPREHENSIVE, AND
SEQUENTIAL EDUCATIONAL
AND SKILL BUILDING PRO-GRAMS
AS WELL AS DIRECT
SERVICES.
At the core of the AHRA Project
was "WIN---WIN---WIN situa-tion
for the student, the school/
district, and the state. From the
adolescents' perspective, they
received pertinent information
about their current health sta-tus
and certain risk behaviors.
In addition, they received sup-portive
information (health mes-sages)
as well as valuable educa-tional
materials (Wellness book-lets,
Fact Sheets, and Resource
Listings).
Throughout the process, howev-er,
the adolescent was reminded
that they were at the center of
their health; they were the deci-sion
makers regarding their own
behaviors; they controlled the
information and the power to
change risky behaviors into
healthy behaviors resulting in
positive health outcomes.
This Project also utilized the
feedback from students to (1)
create Project implementation
policies, (2) produce the Project's
logo, (3) guide health-related
discussions when they arose,
and (4) provide additional infor-mation
that was adapted into
shared materials (i.e. The ADHS
Teen Wellness booklet and Fact
Sheets), Within this framework,
it is recommended that pro-grams
encourage and elicit the
assistance of adolescents during
planning, implementation, and
evaluation of programs for them.
Recommendation #4.. .
THE PARTNERSHIP SHALL
PLAN, IMPLEMENT, AND
EVALUATE COMPREHENSIVE,
CULTURALLY SENSITIVE
SCHOOL- AND COMMUNITY-BASED
PRIMARY (PREVEN-TION),
SECONDARY (INTER-VENTION)
AND TErnIARY
(POST-INTERVENTION)
PROGRAMS, SERVICES, AND
ACTIVITIES IN EACH
SCHOOL and/or COMMUNITY.
The data from the Adolescent
Health Risk Appraisal support
the continuing need for quality
prevention, intervention, and
post-intervention strategies to
address the current adolescent
health issues. However, it is
imperative that these primary,
secondary and tertiary
approaches have several charac-teristics.
First, it is the responsibility of
the Partnership to plan, imple-ment,
and evaluate the interven-tion(~)
i,n order to determine the
effectiveness for their specific
health situation. As evidenced
in the AHRA, schools were able
to identify, through the Post
Data Conference, which areas
where in need of effective pro-gram
planning and implementa-tion.
It was the AHRA which
provided the first set of evidence
(data) to facilitate the need-based
program revisions and
future planning, based on an
assessment specific to that com-munity.
Second, the programs, services,
and activities need to be com-prehensive
in their offerings.
They must look at the adoles-cent
from a holistic perspective
as an active part of a family and
community-based system.
Third, these primary, secondary,
and tertiary strategies must
remain culturally sensitive and
aware of ethnic and racial differ-ences
that exist within the
state's adolescent population.
As the AHRA data suggest, there
were significant differences, not
only in Health Risk Status, but
also in specific areas of behav-ioral
health issues and certain
risk taking behaviors, with
minorities at highest risk in sev-eral
instances.
Fourth, the programs, services,
and activities must be school-and
community-based in order
to meet the needs of those ado-lescents
and their families and
be effective. By being school-and
community-based, these
strategies are made available
and accessible at a much higher
level, As suggested in Healthy
People 2000, the challenge is
for". . .communities to translate
national objectives into State
and local action"(p.7). Creating
such programs, based on needs
assessments and health status
monitoring of the local popula-tion,
is one approach to empow-ering
those who are being appro-priately
served in an effort to
serve them most effectively.
Lastly, the Partnerships that are
established need to provide for
global programs, as well as spe-cific
services and activities.
While the programs are broad-based
in their approach and
scope (see insert), they are not
the complete answer. Additional
services need to be created and
accessed, as well as specific
activities which can be imple-mented.
Nevertheless, pro-grams,
services, and activities
must be provided that are pri-mary
(prevention), secondary
(intervention) and tertiary (post-intervention
in nature.
Recommendations. 5
Recommendation #5. ..
THERE SHALL BE
COLLABORATION BETWEEN
sTATE/COuNTY/CITY/TOWN
OFFICIALS TO PROVIDE
ADEQUATE FUNDING FOR
APPROPRIATE CONSULTATION
AND SUBSEQUENT PLANNING
OF PROGRAMS, SERVICES AND
ACTIVITIES IN EVERY SCHOOL
AND COMMUNITY.
This fifth recommendation is
based on the need for collabora-tion
among all entities identified
on Page 2 of this section.
However, it is vitally important
that government agencies work
collectively with representatives
of a community and community-based
organizations in an effort
to assist them in planning,
implementing and evaluating the
programs, services, and activi-ties
which the community
chooses to support.
In that effort, it important for
governmental agencies to pro-vide
the impetus for such service
delivery changes by offering ade-quate
and sustained funding to
those communities willing to
accept the challenge to improve
the health of their adolescents.
Recommendation #6.. .
PROGRAM EVALUATION WILL
BE INCLUDED IN
THE PLANNING PHASE FOR
ALL PROGRAMS, SERVICES,
AND ACTIVITIES WHICH ARE
CREATED AND THAT
THE EVALUATION PROCESS
WILL BE AN INTEGRAL
COMPONENT TO ANY
PRIMARY, SECONDARY, OR
TERTIARY PROGRAM,
SERVICE, OR ACTMTY.
Based upon Findings from the
Adolescent Health Risk
Appraisal during the three years
that is was implemented, it was
apparent that continuous pro-gram
evaluation would be need-ed
in order to determine the
effectiveness of various actions,
interventions, and programs
that resulted from the AHRA.
Planning for long-term follow-up
of Project participants could pro-vide
useful longitudinal informa-tion
on changes in health sta-tus,
risk taking behaviors, and
general adolescent health.
Furthermore, this document
demonstrates the need for ade-quate
surveillance data and sys-tematic
efforts to collect accu-rate
data on all adolescent
behaviors that effect health sta-tus,
particularly risk behaviors.
Utilizing the AHRA provided only
a minimal needs assessment of
youths around the state.
Because it focused specifically
on 8th and 9th grade students,
there were large cohort groups
(i.e., older adolescents and
dropouts) for whom no data was
collected during the implemen-tation
of this study.
Yet at present, beyond summary
statistics provided by ADHS
Office of Planning and Health
Status Monitoring, the ADE
CAPPE, and ADOT Fatality Data,
there is very limited information
collected and reported on a con-sistent
basis for adolescents
with respect to health. This sit-uation
is further complicated by
the incomparability and incom-patibility
of data types that are
collect by various agencies
based upon different definitions
under which each data set was
created and updated.
Ultimately, program evaluation
must occur for all service deliv-ery
and program implementa-tion.
This is necessary in order
for the various entities involved
with comprehensive adolescent
health in Arizona to be able to
identify effective plans and pro-grams
and to enhance them and
implement them in the most
strategic manner. In addition, it
is stressed that evaluation
must be planned then initiat-ed
at the beginning of program
implementation and conduct-ed
on a consistent basis
throughout the duration of
the project, with follow- up
data being sought on a regular
basis from program partici-pants.
Effective evaluation can
not be an afterthought.
The effectiveness of such com-prehensive
strategies, as pro-posed
within these Recommend-ations,
will be seen'when evalu-ation
is an integral part of every
program, service, or activity.
Recommendations. 6
The Evaluation process and plan
must include:
+ Formative evaluation
(assessment of the formation
of interventions including
documentation of the cre-ation
of infra-structures)
+ Process evaluation
(measurement of actions,
encounters, and degree to
which target populations are
being served)
+ Impact evaluation
(assessment of changes in
knowledge, attitudes, and
behaviors of persons or sys-tems
receiving services)
+ Outcome Evaluation
(measurement of the degree
to which a community or
population's health status
has improved [i. e., morbidity
and mortality statistics,
drop-out rates, shifts in
severity of disease states).
While products of outcome eval-uation
are the ultimate standard
of determining a program's effec-tiveness,
they are long-term
indicators which may be difficult
to collect and relate to specific
program initiatives.
Effectiveness will be achieved
when the emphasis for provision
of services to adolescents and
others is based on service inte-gration
which is culturally sensi-tive,
community-based and
age-appropriate, with adequate
access to those services which
are rendered.
Strategizing To Meet
Healthy People 2000
Objectives
From the description of
Adolescents and Young Adults
in the introduction to Healthy
People 2000:
"The years from 15 to 24 are a
time of changing health haz-ards.
Caught up in change and
experimentation, young people
also develop behaviors that may
become permanent. Attitude
and patterns related to diet,
physical activity, tobacco use,
safety, and sexual behavior may
persist from adolescence into
adulthood.
The dominant preventable
health problems of adolescents
and young adults fall into two
categories: injuries and vio-lence
that kill and disable many
before they reach age 25 and
emerging lifestyles that affect
their health many years later."
(P. 16)
Knowing this information, it is
imperative we remain mindful of
the target areas, many of which
were addressed in the AHRA.
These areas, (with specific
health status, risk reduction,
service and protection objectives
as well as research needs), are
presented in the accompanying
table. They focus on:
d Motor Vehicle Crash
Injuries
d Homicide and Suicide
d Lifelong Health Habits
d Tobacco, Alcohol and
Drugs
d Sexual Behavior.
These target areas are presented
in the Tables found on pages 8
and 9. Below each target area,
facts regarding the associated
behaviors are highlighted.
These are followed by a subset of
specifically selected Healthy
People 2000 Objectives (para-phrased
for brevity) designed to
address those specific areas.
It is understood that there are
identified problems with adoles-cent
health in Arizona, as well
as the Nation. The AHRA has
identified specific behavior risk
areas that challenge us as com-munities,
at large. There is an
awareness that these problems
are multi-faceted and complex.
Through the implementation of
the Recommendations presented
here, in order to strategize to
meet Healthy People 2000 objec-tives,
effective change can occur
for young people, today and
tomorrow. It is by working with-in
our communities, actively
participating in planned
Partnerships, that we will be
able to accomplish goals that
alone any one of the entities
involved in adolescent health
would deem impossible. It is by
working together to meet the
needs of the future that we are
able to better serve our adoles-cent
population with respect to
improving their health, promot-ing
their future development,
and assisting them in their
growth, development, and sur-vival.
Recommendations. 7
Comments
Recommendations. 10
Recommendations. 1 1
Recommendations. 12
As part of our continued commitment to the Evaluation Process and Qudity Improvement, any feed-back
which we receive will be reviewed and assessed. Your comments and suggestions regarding the
content, layout, or presentation of this document are greatly appreciated.
Please return this form to:
Adolescent Health Consultant
Arizona Department of Health Services
Office of Women's and Children's Health
1740 West Adams, Room 200
Phoenix, AZ 85007
Your Comments and Interpretations
Recommendations. 13
Arizona Department of
Education, Comprehensive
Health Unit, Chemical Abuse
Prevention Program. ( 1992a).
Chemical Abuse Prevention
Program Evaluation School
Questionnaire for the 1991 -
92 School Yew.
Arizona Department of
Education, Comprehensive
Health Unit. (1992b).
Chemical Abuse Prevention
Program Evaluation (CAPPE),
Executive Summary, Aqust
1992.
Arizona Department of
Education, Special Programs
Division. ( 1 99 1 a). Model
Policies and Procedures:
Alcohol and Other Drug
Prevention.
Arizona Department of
Education, Comprehensive
Health Unit. (199 lb).
Chemical Abuse Prevention
Program Evaluation (CAPPE),
Executive Summary, January
1991.
Arizona Department of
Education, Comprehensive
Health Unit. (1991~).
Analyses and Summary of
1988-1 990 of the Chemical
Abuse Prevention Program
Evaluation.
Arizona Department of
Health Services, Office of
Women and Children's
Health. (1993). Status of
Adolescent Health in Arizona:
A Report of the Arizona
Adolescent Health Coalition
(Draft).
Arizona Department of
Health Services, Office of
Women and Children's
Health, Arizona Adolescent
Health Coalition (1993).
Meeting Minutes for April 13,
1993.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1992a). Arizona
Health Status and Vital
Statistics 1990.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1992b). Drug-
Related Mortality, Arizona
1990.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1992~).
Firearm- Related Fatalities,
Arizona 1990.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1 992d). Injury
Mortality Among Children
and Adolescents, Arizona
1990.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1992e).
Sexually Transmitted
Disease, Annual Surveillance
Report, Arizona 1992.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (19920. Suicide
Mortality, Arizona 1990.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1 992g).
Teenage Pregnancy, Arizona
1991.
Arizona Department of
Health Services, Office of
Planning and Health Status
Monitoring. (1992a).
Unintentional Drowning
Deaths, Arizona 1990.
Center for Disease Control.
(1990). Chronic Disease and
Health Promotion, Reprints
from the Morbidity and
Mortality Weekly Report
(MMWR): 1990 Youth Risk
Behavior Surveillance
System
Colorado Department of
Health, Advisory Council on
Adolescent Health. (1986).
Adolescent Health in
Colorado: Status,
Implications, and Strategies
for Action.
Colorado Department of
Health, Advisory Council on
Adolescent Health. (1992).
Adolescent Health in
Colorado: Status,
Implications, and Strategies
for Action.
Morrison Institute for Public
Policy (1992). Kids Count
Factbook: Arizona's Children
1992.
National Adolescent Health
Resources Center, University
of Minnesota; Department of
Pediatrics, Medical School.
(1 990). Conducting an
Adolescent Health Survey.
National Adolescent Health
Resources Center, University
of Minnesota, Department of
Pediatrics, Medical School.
( 1993). Conducting an
Adolescent Health
Community Needs
Assessment.
Rhode Island Department of
Health, Office of Health
Promotion (1985). Teen
WeUness Check, Version 1.2,
Operator's Manual.
United States Department of
Health and Human Services,
Public Health Service, Health
Resources and Services
Administration, Alcohol,
Drug Abuse, and Mental
Health Administration
(1993). Report of the
Secretary's Task Force on
Youth Suicide.
United States Department of
Health and Human Services,
Public Health Service, Health
Resources and Services
Administration ( 199 1).
Healthy Children 2000:
National Health Promotion
and Disease Prevention
Objectives Related to
Mothers, Infants, Children,
Adolescents, and Youth.
United States Department of
Health and Human Services,
Public Health Service, Health
Resources and Services
Administration (199 1).
Healthy People 2000:
National Health Promotion
and Disease Prevention
Objectives.
The National Committee for
Injury Prevention and
Control (1989). Injury
Prevention: Meeting the
Challenge. [Supplement to
the American Journal of
Pediatrics, 5, N0.31.
References. 2
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
1. Are you:
blah ( ) Female ( )
2. Your age is:
13 or under ( ) 14 ( 15 (
16 ( ) 17 ( 18orover ( )
3. What do you consider your racelethnic group to be?
A. White (non hispanic origin) ( 1
6. Black (Afro-American origin) ( 1
C. Hispanic ( )
D. Asian or Pacific Islander ( )
E. Native Am. Indian or Alaskan Native ( )
F. Other ( 1
4. What grade are you in now?
7th ( 8th 0 9th ( 1
10th ( ) 11th ( 1 12th (
5. What is the highest grade you plan to complete?
7th ( 1 8th 0 9th 0 10th ( )
11 th ( ) 12th ( ) College ( )
6. Has a blood relative (parent, grandparent, brother, or
sister) had either a heart attack, a stroke, high blood
pressure, or diabetes before the age 603
A. Yes ( ) B. No ( ) C. Don't know ( )
7. How would you describe your body frame?
A. Largeboned ( ) B. Average ( ) C. Smallboned ( )
8. How tall are you (with shoeslone inch heels)?
A. 4'9 or under ( )
6.4'10"-4'11" ( )
C.5'0"-5'1" ( )
D. 5'2" - 5'3" ( )
E.5'4"-5'5" ( )
F. 5'6" - 5'7" ( )
G.5'8"-5'9" ( )
H. 5'10"-5'11" ( )
1.6'0"-6'1" ( )
J. 6'2" - 6'3" ( )
K. 6'4"- 6'5" ( )
L. 6'6" or over ( )
9. What is your weight? (wearing indoor clothes)
A. 89 lbs or less ( ) B. 90 to 99 ( 1
C.100to109 ( ) D. 110to119 ( )
E. 120 to 129 ( ) F. 130 to 139 ( 1
G. 140 to 149 ( ) H.150to159 ( )
1. 160to169 ( ) J. 170to179 ( 1
K.180to189 ( ) L. 190to199 ( 1
M. 200 to 209 ( ) N.210to219 ( )
0. 220 to 229 ( ) P. 230 Ibs or more ( )
10. How many days in a typical week do you eat breakfast?
A. Every day ( 1 B. 5 or 6 days a week ( )
C. 2 to 4 days a week ( ) D. 1 day or none ( )
11. How many days in a typical week do you eat foods
from each of the four food groups?
The four groups are:
1. Fruits and vegetables 3. milk or milk products
2. breads, grains andlor cereals 4. meat: fish or plant
proteins
I eat something from each of these four food groups ...
A. Every day ( 1
B. 5 or 6 days a week ( )
C. 2 to 4 days a week ( )
D. 1 day or none ( )
12. How often do you snack on foods like pastries,
candy, sweets, soft drinks, or other sugary foods?
A. Daily ( 1
B. At least 3 times a week ( )
C. Seldom ( )
D. Never ( )
13. How often do you brush your teeth?
A. Daily ( ) B. At least 3 times a week ( )
C. Seldom ( ) D. Never ( )
14. How often do you use dental floss on your teeth
and gums?
A. Daily ( ) B. At least 3 times a week ( )
C. Seldom ( ) D. Never ( )
A
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
15. Have you had your teeth checked andlor cleaned at
a dentist's office or clinic in the past 12 months?
yes ( ) No ( 1
16. Have you been immunized (received shots) to protect
you against measles and German measles (rubella)?
A. Yes, both ( ) B. Yes, one ( )
C. Neither ( ) D. I don't know ( )
17. How often do you walk at least one mile without
stopping?
A. Daily ( ) B. At least 3 times a week ( )
C. Seldom ( ) D. Never ( 1
18. Aerobic exercise is any physical activity that greatly
increases both heart rate and breathing. Aerobics
can include exercising, jogging, swimming, jumping
rope, crosscountry skiing, brisk walking, or other
strenuous activities. How often do you get at least
20 minutes of non-stop aerobic exercise?
A. Daily ( ) D. Seldom ( )
B. At least 3 times a week ( ) E. Never ( )
C. Once or twice a week ( )
21. Do you plan on quitting some day?
A. I do not smoke ( )
B. No, I do not plan on quitting ( 1
C. Yes, I plan to quit today or in the very near future ( )
D. Yes, I plan to quit before I get out of high school ( )
E. Yes. I plan quii I 21 Years ( 1
F. I will only quit if forced to by illness or disease ( )
22. Does marijuana smoke contain more cancer causing
agents than tobacco smoke?
Yes ( 1 No ( )
23. In a typical week, what is the most alcohol you drink
in any one day? (A drink of alcohol is either 12 oz.
of beer, a 5 oz. glass of wine, or a 1 1i2 oz. shot of
hard liquor). In a typical week, the most I drink in
any one day is ...
A. None, I do not drink ( )
B. 1 or 2 drinks in one day ( 1
C. 3 or 4 drinks in one day ( 1
D. 5 or 6 drinks in one day ( )
E. 7 or 8 drinks in one day ( )
F. 9 or 10 drinks in one day ( )
G. 11 or more drinks in one day ( )
19. How often do you participate in recreational activities - such as bowling, golf, tennis, basketball, softball,
dancing, or similar activities?
A. Daily ( ) D. Seldom ( )
B. At least 3 times a week ( ) E. Never ( )
C. Once or twice a week ( )
20. How many cigarettes (tobacco) do you smoke or
dips do you use?
A. None, I have never used tobacco ( 1
B. None, I quit ( )
C. A pack or a dip or less per week ( 1
D. More than a pack or dip per week,
but less than one per day ( 1
E. 1 pack or dip per day ( 1
F. 1 to 2 packs or dips per day ( )
G. 2 or more packs or dips per day ( 1
24. Is the abuse of alcohol (a depressant) or any other
drug dangerous?
Yes ( ) No ( 1
25. Do you ever use alcohol with any other drugs?
A. No I don't ( 1
B. Yes, often ( 1
C. Yes, sometimes ( )
D. Yes, but very seldom ( )
26. Do you ever drive under the influence of alcohol or
drugs, or ride with a driver who is?
A. No I don't ( )
B. Yes, often ( )
C. Yes, sometimes ( )
D. Yes, but very seldom ( )
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
27. How often do you use seatbelts when you drive
or ride in a car?
A. Always or nearly always ( ) B. Sometimes ( )
C. Seldom ( ) C. Never ( )
28. When driving a car, do you ever exceed the speed
limit by more than 10 miles per hour?
A. Not driving yet ( 1
B. Never exceed speed limit by 10 mph ( )
C. Rarely exceed speed limit by 10 mph ( )
D. Sometimes exceed speed limit by 10 mph ( 1
E. Often exceed speed limit by 10 mph ( )
29. If you ride a motorcycle, or moped, or bicycle, do
you wear a helmet?
A. Don't ride any of them ( 1
B. Never wear a helmet ( 1
34. Do you know how to swim or stay afloat in water that
is over your head?
Yes ( 1 No ( 1
35. Have you lost more than five pounds in the past few
months without dieting?
Yes ( ) No ( 1
36. Do you usually get enough sl ~ eapn d feel rested in
the morning?
A. Yes, usually ( 1
B. Yes, sometimes ( )
C. No ( )
37. In the past six months, have you had feelings
C. Rarely wear a helmet that life wasn't worth living?
D. Sometimes wear a helmet
E. Always wear a helmet
B. Yes, sometimes
30. When walking or jogging on a road, which side of D. No I haven't
the road do you walk or jog on?
38. Do you have friends or relatives that you can turn to
for help when something is troubling you?
B. Yes, sometimes
39. Can sexual intercourse even once, without effective
B. Yes, sometimes birth control, result in pregnancy?
C. Yes, often or always
32. Do you have a smoke detector in your home or 40. Will sexual activity with several partners increase
a person's chances of getting sexually transmitted
diseases (STD's)? Sexually transmitted diseases
are sometimes called venereal diseases (V.D.)
B. Yes, and I'm sure that it works
C. Yes, but it may not work
D. I don't know
33. Do you ever hitchhike or pick up hitchhikers?
C. Yes, sometimes ( )
D. Yes, but very seldom ( 1
FEMALES
Please Continue (other side)
Teen Wellness Check
Please Answer Every Question Mark Answers On Card
Wellness Check was developed by the Rhode Island Department of Health
FEMALES ONLY SHOULD ANSWER THESE LAST SIX QUESTIONS ...
41. Do you examine your breast each month to
detect lumps?
yes ( No ( 1
42. Has your mother or sister had a breast removed or
an operation on her breast?
A. Yes ( )
B. No (
C. I don't know ( )
43. Has your mother or sister had a hysterectomy
(uterus removed)?
A. Yes ( 1
B. No ( 1
C. I don't know ( )
44. If you've started having menstrual periods, do they
ever last for more than 10 days at a time?
A. I've not not started having periods yet ( 1
B. Yes, my periods have lasted for more than 10 days ( )
C. No, I've not had a period last for more than 10 days ( )
45. Do you know what caused your period to last more
than 10 days?
A. Does not apply ( ) B. Yes ( ) C. No ( )
46. Are women who take birth control pills and smoke
cigarettes at an increased risk of blood clotting?
A. Yes ( ) B. No ( ) C. I don't know ( )
You have completed the Wellness Check risk assessment questionnaire.
Thank You!
TEEN WELLNESS CHECK ADVISORY MESSAGES
Your score on the health risk appraisal is out of 100 points.
Your score places you in the following health risk category:
Excellent (85-1 00)
Fair (70-84)
Risky (55-69)
Hazardous (0-54)
You scored well in the following areas of the questionnaire:
Criieria for printing (S13 means score for question 13). See scored questionnaire.
Diet SlO+Sl1=2
DentalHealth S13+S14+S15=3
Exercise S17+S18+S19=2
Smoking S20 + S21 greater than 1
Alcohol S23 + S25 greater than 0
Auto Safety S26 + S27 + 528 + S29 + 530 + S31 + 532 > 5
Mental Health S35 + S36 + S37 + S38 = 0
You should be proud of the way you take care of yourself in these categories. If you would like information to help
you to maintain or further improve these good health habits, please refer to 'The Way To Wellness For Teens"
booklet you received.
No matter how you answered the questions about drugs and sexuality, everyone is receiving the following mes-sages,
(messages 9,11, 24, 25 and 30 (females only) are printed here.)
(Any of the following messages may be printed. The criteria are listed in the questionnaire given in the
previous section.)
1. * Close relatives of yours have had one or more of the following before age 60:
Heart Attack
Stroke
High Blood Pressure
Diabetes
This family history increases your chances of developing the same condition. Reducing those risk factors
that you can control becomes even more important to you.
2. ' You may be over your ideal weight. You would look and feel better if you ate sensibly and exercised
regularly. Since you may still be growing, don't try to lose weight without consulting a doctor or your
school nurse.
3. ' Try not to skip breakfast, it is the most important meal of the day. Your body needs the energy to get
you through each day.
4. * What you eat definitely effects your health. Try to eat a variety of foods from the four food groups, and
maintain your ideal weight.
5. ' Try to limit sugary foods if you are overweight or if you tend to get cavities.
6. * If you neglect the care of your teeth you are at high risk for tooth decay and gum disease. You should
brush your teeth and use dental floss every day.
7. ' You may not be up to date on your immunizations. This increases your chances of getting measles or
rubella (German measles). Check with your parents, school nurse, family doctor, or local clinic.
* Even though you may play sports or get other forms of exercise, a regular program of aerobic exercise
would be good for your health. To be considered aerobic, the activity you choose must greatly increase
your breathing and heart rate, and continue non-stop for at least 20 minutes, three or more times each
week. Aerobic exercise can include brisk walking, jogging, swimming, cross-country skiing, dancing,
biking, or any other vigorous activity.
Smoking is a major health hazard at any age. It's costly, gives you bad breath;makes your clothes
smell, causes premature wrinkles on your face, and shortens your breath. It is also the major cause of
lung cancer, heart disease, chronic emphysema, and premature death. If you quit now, your body can
return to normal in a very short time.
* Besides marijuana's cancer-causing agents, you should know that marijuana use can affect your think-ing,
memory, concentration; it can lower male hormones in boys and female hormones in girls which
may affect your physical or sexual development; it can also interfere with driving ability and coordination.
* If you continue to drink alcoholic beverages at your present rate you may become an alcoholic even
at your age. You are also more likely to encounter physical and social problems associated with
alcoholism, like trouble relating to people, trouble concentrating in school, and lower resistance to infection.
You should know that alcohol can be a dangerous drug. You should also know that abuse of many kinds
of drugs can lead to permanent physical and mental damage and/or addiction. Overdoses of some
drugs can and do kill. Sniffing or inhaling substances is especially damaging and deadly. Illegal drug
users can never be sure of the 'quality" of drugs they are using. Drug abuse results in loss of self-control.
* Alcohol, when combined with other drugs, can be fatal. Alcohol and barbiturates or tranquilizers taken
together can slow down breathing and heartbeats to the point of death. When alcohol is combined with
stimulants the effects of either drug may be dangerously increased. Combining alcohol and marijuana
can cause more problems than either drug taken alone, especially when driving.
* Alcohol related traffic accidents kill and cripple tens of thousands of innocent people every year. Both
alcohol and drugs greatly reduce reaction time, increasing your chances of causing or being unable to
avoid a serious accident.
" Each year automobile accidents kill and cripple tens of thousands of teens and young adults. It is the
number one cause of death and serious injury for your age group. By wearing seat belts, you greatly
decrease your chances of serious injury or death.
* Speed kills. By driving no faster than the speed limit and driving defensively, your chances of being
involved in an auto accident would be considerably reduced.
* Riding a motorcycle or moped without a helmet places you at increased risk of serious injury or death in
the event of an accident.
* When walking or jogging on a road, you should always walk or jog 30 that you are facing the
oncoming traffic.
When jogging, walking, or riding a bike after dark, always wear light colored clothing, preferably a
reflective vest, or be sure your bike has reflectors. You may see car headlights after dark, but without
reflective clothing, the driver may not be able to see you.
* Hitchhiking is a dangerous practice that can result in kidnapping, injury, rape, and even murder. Picking
up hitchhikers places you at the same risks.
21. * If you spend time in or near the water, you should learn how to swim or stay afloat. Otherwise, you
should wear an approved personal floatation device.
22. An unintentional loss of weight or appetite may be caused by stress and anxiety or may be the result of
a physical problem. If you have experienced an unexplained weight loss, you should check with your
school nurse or counselor or family doctor.
23. ' Your own moods and stresses may be endangering your overall health. Prolonged stress is assodated
with illness such as high blood pressure, heart disease, gastric ulcers, alcoholism and mental or emo-tional
illness. Find healthy ways to relax, like exercising. You may need to talk things over with some
one in your family, a close friend, your school counselor, or someone else who is a good listener.
24. * Feeling really down emotionally happens to almost everyone occasionally--but-it can seriously harm
your health. If you find yourself feeling that life isn't worth living, don't do anything hasty. Seek out those
sources of help that are available to you.
25. Sexual intercourse--even once--without effective birth control, can result in pregnancy.
26. A person may have a sexually transmitted disease (STD) and not know it until permanent damage is
done. You should know that persons who are sexually active with different partners should be checked
for sexually transmitted diseases (STD's) frequently so that they can be treated, if necessary.
27. * You are not taking proper precautions against breast cancer. By beginning a habit of breast
self-examination, your risk from this disease would be greatly reduced.
28. * Although breast cancer is extremely rare in women your age, you may be at a greater risk if your
mother or sister had breast cancer. Be sure to get in the habit of breast self-examination.
29. Although cancer of the uterus is extremely rare in women your age, you might be at a greater risk if your
mother or sister had her uterus removed. Be sure to check with your doctor about how often you should
have a Pap test, which detects cancer early while it can be cured.
30. Menstrual periods that last for ten days or more may be a signal of some disorder. See your school
nurse, doctor, or clinic to identify the problem.
31. * You should know that smoking can result in constriction of blood vessels and poor circulation. When
combined with possible clotting effects of the pill, the result can be a stroke. if you are taking the pill, you
have a special reason not to smoke.
32. * Too much weight is a condition that follows teens into adulthood and may result in serious health
problems such as diabetes, chronic high blood pressure, heart disease, strokes, and even sudden death.
Help is available. Speak with your school nurse, family doctor or local clinic to develop a safe and
healthy eating pattern.
33. * You may be under your ideal weight. It is important that you eat enough food to meet your body's high
energy needs. Dieting to maintain your figure or physique can rob your body of nutrients essential to
normal growth.
34. * Properly installed and working smoke detectors in the home can warn your family of a fire while there is
still time to get to safety.
35. * You should floss your teeth daily to protect both your teeth and gums. If you do not floss regularly, you
run the risk of losing of losing your teeth from gum disease in the middle age, even if you have few or
no cavities.
................... ....................................
WELLNESS FOR TEENS
ARIZONA DEPARTMENT OF HEALTH SERVICES
Arizona Department Of Health Services
Division Of Family Health Services
Office Of Women's And Children's Health
1740 West Adams, Phoenix, Arizona 85007
(602) 542-1880
DF:WLTEENBRCHP
7/93 flr
RESOURCES IN ARIZONA FOR TEENS
Diet And Nutrition
Nutrition Services, Arizona Department of Health Services
Dairy Council of Arizona
"WELLNESS FOR TEENS" WAS DEVELOPED TO PRO-VIDE
INFORMATION ON TOPICS PERTAINING TO
HEALTH AND SAFETY. THE INFORMATION IS IN-TENDED
TO HELP INCREASE YOUR AWARENESS OF
THOSE CHOICES YOU MAKE THAT COULD AFFECT
YOUR HEALTH AND WELL-BEING.
ADOLESCENT HEALTH
ADHSIOWCH 7/93
flr
Cooperative Extension: 4H Clubs;
Food & Nutrition Programs
Local County Health Department
Dental And Health
Dental Services, Arizona Department of Health Services
Phvsical Fitness
Local Parks & Recreation Department
Smoking
American Cancer Society
Arizona Lung Pssociation
(See Phone Book for County Office)
(See Phone Book)
(See Phone Book)
Alcohol
National Council On Alcoholism And Drug Dependency 264-6214
Alcoholics Ano~nyrnous (See Local Listing in Phone Book)
Drugs: Substance Abuse
Community Behavioral Health Services, Arizona Department of Health Services 220-6478
Governor's Office of Drug Policy 542-3456
1-800-533-8920
Traffic Safety
Governor's Office of Highway Safety
Stress
Community Behavioral Health Services, Arizona Department of Health Services 220-6478
Local County Health Department (See Phone Book)
Imrnunizatiaq
Disease Controll, Arizona Department of Health Services
Local County Health Department
Sexualitv and Birth Control
Planned Parenthood of Arizona
Local County Health Department
P ~TDes t and Breast Self-examination
~miricanC ancer Society
Heart AttacWStroke
American Heant Association
Diabetes
American Diabetes Association
230-5852
(See Phone Book)
277-7526
(See Phone Book)
GENE=, 'The Public Health Nurse at your local county health department is aware of local
community health resources. Your local Department of Economic Security office also has listings of
community resources. Churches and synagogues are other resources in a community that may provide
assistance. When calling for help, it is not always necessaly to identify yourself, just ask the question
or briefly state the problem that you wish assistance with.
(The above phone numbers were correct as of December, 1992)
WATER SAFETY
are fun activities which can be done all year in
Arizona. Swimming is one of the best forms of exercise because it does not put
extra pressure on joints and spine. When you are around water, there are certain
things to remember to make sure that your fun does not turn into disaster.
Always swim with a "buddy". That way someone will know if you run
into a problem.
Don't drink alcohol or use other drugs. Alcohol and other drugs slow
your judgement and reaction time.
Don't swim when you're overtired or feeling chilled. Your muscles may
cramp, preventing you from reaching the shore or edge of the pool.
Diving injuries can be very serious. Almost 1,000 people every year become
paralyzed when they injure their spinal cord while diving. Most diving injuries
can be prevented by following these rules:
Always know the depth of the water. Depth can vary at different areas
of the same lake, pond, or river.
e Always jump feet fust on your fust plunge even if you think it's safe to
dive.
Be sure there are no submerged objects, like rocks, in your path. Plan
your path before diving.
When you Do Dive:
Keep your arms extended along the side of your head, in the direction
of the line of flight, with hands together, palms down and thumbs
touching, to cut the impact of the water on the top of the head and to
protect you from injury.
Don't dive into less than 5 feet of water, or into the shallow end of a pool.
Remember when you are boating you use the same skills as driving a car.
Therefore, follow these rules:
Be careful to avoid collisions with other boats: don't "play chicken".
Be aware of swimmers, skiers or people using jetskis in your area.
There are no traffic lights or crosswalks in lakes!
Teen= drowning injuries are often (75% of the time) a result of using alcohol
Dr other druvs. Alcohol and other drugs slow your
minin vour abilities, the pagage of time, or your
surroundings is decreased, making you take chances
which could result in permanent physical dam=.
Making mistakes is human; but don't make a mistake
that you can avoid easily by not mixing drugs and
water sports.
SAY WHAT YOU WANT TO SAY
There are some people who want to say "NO", but say "YES" instead.
Do you find it hard sometimes to stand up for what you believe in or for your
rights? If yes, why? Maybe:
You are afraid of not being accepted.
You are afraid of being embarassed.
You are afraid your friends won't like you anymore.
You don't think anyone listens.
You don't believe you are important.
You are important and you have the right to say and do what you feel is best for
you.
The following are some ideas you may find helpful if you find yourself saying
"YES" when you really mean "NO":
Standing up for yourself in a healthy way
1. Say clearly what it is you really want, or how you feel. Use sentences that
begin with "I". For example: "I am angry that you lost my tape. I would like
you to replace it."
2. Say why you feel this way.
3. Tell the other person that you understand their feelings, and ask if they
would try to understand yours.
When you are feeling under pressure:
1. Delay making a decision. Sometimes a little space and time is helpful when
dealing with a difficult situation. This will give you some time to think about
how you can deal with the person or situation more directly the next time.
2. Talk it over with a friend. You may not be the only one who feels the way
you do.
3. If you think your friendship is on the line, ask: "Do I have to do this to be
your friend?" A person isn't really a friend if he or she tries to pressure you
to do what you don't want to do. You deserve better!
HOW YOU FEEL ABOUT YOURSELF THE SUN RAYS AND YOU
Self-esteem is how you feel about yourself. If you have high self-esteem you will What's Healthy:
tend to feel good about and believe in yourself and feel that you are important. Sunlight, in small amounts on the skin, help produce vitamin D, which is important
If you have low self-esteem you will tend to feel negative about yourself and feel for building strong bones.
unimportant.
Your attitude about yourself will also affect your behavior. You tend to act like What's Not Healthy:
the person you believe yourself to be. Too much sunlight when you're young can cause wrinkles and skin cancer later in
I:$-
It's common for teenagers to have doubts about themselves, and to not like
themselves sometimes. This is a part of growing up. There are a variety of things
you can do to help yourself through the doubtful times or to help improve your
self-esteem. The following are some ideas that may be helpful.
1. Think of at least three of your best qualities. Remember, there are other
qualities besides being athletic, popular or making good grades. Do the
words kind, helpful, loving, responsible or good listener describe you?
Remind yourself of your qualities whenever you feel down on yourself.
2. It's okay if you fmd yourself comparing yourself to others from time to time;
most people tend to do that. It's a way to learn and think about the kind of
person you want to be or don't want to be. Keep in mind, there's a good
chance that you'll find someone smarter, faster or more talented than you in
some things because there are very few people that can be the best at
everything. The most important thing is to be the best that YOU can be.
3. Think of the quality you like least about yourself and make a plan to improve
it.
4. Try not to generalize. Just because you had a fight with your parents, or failed
your math test, doesn't mean you're a bad person or dumb. It means that
ups and downs will occur in your life. The important thing is to try to work
through the ups and downs, resolve them and learn from them.
5. Sometimes it's easy to get down on yourself, remembering only the negative
things and forgetting the positive. Practice telling yourself good things like:
"I'm okay".
"I may not be perfect".
"I sure do have potential".
e "If I really work at it, I can be who I want to be".
You Should Know:
The sun is strongest between 10 A.M. and 3 P.M. Everyone should be
aware of the amount of time spent in the sun. Persons with light-colored
skin and hair, redheads, and anyone with a family history of skin cancer
need to pay special attention to the amount of time in the sun.
Skin cancer is a major problem in the Arizona desert because the sun's
rays are so intense.
Skin cancer is the most curable of all cancers if found early.
Here Are Things That YOU CAN DO To Protect YourselE
1. Avoid sunburn by covering up in bright sun by wearipg a shirt and hat when
outdoors playing, working or enjoying water sports. Don't be fooled by a
cloudy day,, ultraviolet rays can pass through clouds and cause sunburn as well.
2. Apply sun.w, reen. CNPR TE -
TIVE FACTOR. There are different strengths of SPF, each giving different
protection in the sun. The smaller the SPF number the less the protection;
the larger the SPF number increases the protection. To figure out the time of
protection, multiply the minutes you normallv start to burn in the sun without
any protection by the sunscreen SPF number. For example: If you normally
burn in the sun in 10 minutes without protection, a sunscreen with SPF #4
gives 10x4 = 40 minutes of sun protection. Reapply sunscreens frequently
due to sweating, swimming and/or wind. A waterproof sunscreen is a good
idea, but it too will need to be reapplied. The University of Arizona Cancer
Center rec~ommendasn y sunscreen with an SPF #15 or more. There are many
different types of sunscreen that you can buy, so talk with your doctor or
pharmacist to find out which is the right one for you.
3. Apply sunsicreesn 30 minutes before going out into the sun.
4. Don't stay out in the sun too long.
5. Consult your doctor or pharmacist before going out in the sun if you are taking
medication. There are some medications that don't react well with sun.
6. You should know your own skin moles and freckles; see a doctor if you develop
new ones or if they change in shape, size or color.
QUITTING CIGARE'ITES OR SMOKELESS TOBACCO
If you're a user and want to stop, here are some tips that may help:
Think about all the reasons why you want to quit; write some of them
down to remind yourself in case you become tempted.
Giving up a habit is not easy, so be kind to yourself. It will take time. If
you find yourself becoming irritable, take a few minutes to relax and
collect yourself.
BEFORE YOU QUIT:
Change to a brand you don't like.
Postpone your first cigarette or chew of the day by one hour for a few
days, then by two hours, then three, etc.
Set a date for quitting.
WHEN YOU QUIT:
Get rid of all of your tobacco.
Tell everyone you know you're quitting.
Have sugarless gum available for when you have the urge to chew.
Save the money you would have spent on tobacco and treat yourself to
something you wouldn't usually buy.
WHEN YOU HAVE THE URGE TO USE TOBACCO DO ONE OF THESE
THINGS INSTEAD:
Take a walk or exercicse with a friend.
Drink a glass of water or snack on some fruit.
IF YOU FEEL THAT YOU NEED MORE ASSISTANCE IN QUITTING.
Talk with your doctor or dentist.
Call the American Cancer Society at 1-800-227-2345.
Call the Arizona Lung Association at (602) 458-7505.
AIVER YOU HAVE QUIT:
Don't worry if you are sleepier or more irritable than usual; these
symptoms should go away.
When you're in a tense situation try to keep busy. Tell yourself that
smoking or chewing won't solve the problem.
Don't give up. YOU ARE WORTH IT!!!
HELPING SOMEONE QUIT
Being supportive of someone trying to give up tobacco is the best thing you can
do. Let the person know that you care and will help if he or she needs it. Try to
reduce stress factors that will add to the already stressful situation your friend or
family member may be experiencing.
BREAKFAST IS SMART
Breakfast Gives You Energy To:
BeSmart. Be Stronger.
Look and Feel Gdod. Be Active.
Learn More Easily. Think Better.
Usually it is about twelve hours between your evening meal and breakfast. If you
skip breakfast, your body goes sixteen hours without rebuilding your energy
supply for a new day. Energy comes from the foods you eat. Energy helps you
and your body to function and stay healthy. Start your day off right, EAT
BREAKFAST. BREAKFAST IS IMPORTANT!
BREAKFAST IS FAST
"Not enought time" is why many students say they don't eat breakfast. Breakfast
doesn't have to take long. Try these:
Minutes To Prepare:
cereal; milk; juice
toast with peanut butter or cheese; milk; fruit
frozen waffles; pancakes; milk; juice
quick-cooking hot cereal (takes 1-2 minutes) (add raisins if you like)
warm up leftovers from dinner
cottage cheese; toast; juice
egg; toast; muffin; milk; juice
Food For Thou~htI.f you go to bed earlier and get up earlier, you may find you'll
have the extra time you need to eat breakfast.
BREAKFAST CAN TRAVEL
If you can't eat when you get up, take breakfast with you to eat a little later. (Note
"For Safety" at bottom of page.) Try these:
fruited yogurt; graham crackers; juice
fresh fruit; peanut butter sandwich; milk
English muffin (peanut butter, cheese, etc.); juice
hard-cooked egg; whole grain bread; fruit or juice (cook several eggs
ahead, keep up to a week in the refrigerator)
muffin; fruit; milk
leftover meat sandwich (made the night before) and fruit
lunchables
FOR SAFETY: MAKE SURE TO KEEP COLD FOODS (LIKE MILK,
YOGURT, MEATS) COLD AND KEEP HOT FOODS HOT. DO NOT LEAVE
THESE FOODS AT ROOM TEMPERATURE FOR MORE THAN TWQ
HOURS. (THINK ABOUT USING ATHERMOS FOR HOT FOODS AND AN
INSULATED BAG WITH AN ICE PACK FOR COLD FOODS).
DENTAL WISE
Taking care of your teeth now can be a wise move on your part. Here's why:
Your teeth are meant to last a lifetime. If you lose your teeth at a young
age, it affect how you look.
Plaque is a sticky, colorless film of bacteria that forms on the teeth every day. If
plaque is not removed daily, the bacteria breaks down and forms lactic acid that
irritates the gums, making them swollen, tender and likely to bleed as well as
help cause teeth to decay.
Here's What You Can Do:
1. See your dentist for regular check-up visits, at least once a year.
2. Brush and Floss&&! This will keep your teeth and gums healthy. You
will have fresh smelling breath and a nice smile.
DENTAL NEWS FLASH - - - - SEALANTS
Most tooth decay in adolescents takes place on the chewing surfaces of molars.
Decay happens because these surfaces contain pits and grooves. Your dentist
can apply DENTAL SEALANTS, which flow into and coat the pits and grooves
so that bacteria cannot multiply and cause decay.
Sealants: Can last as long as five years.
Drilling is not needed.
Could be checked during regular dental vists.
Can be easily replaced if necessary.
SMOKLESS TOBACCO
You may know smokeless tobacco as chewing tobacco or snuff. Some kids use it
because they think it looks cool or their friends, coach, or relatives use it.
Smokeless tobacco is not a safe choice to make in place of smoking. Smokeless
tobacco contains things that are harmful to your body like: sweeteners, nicotine,
salts and carcinogens (substances that causes cancer).
Chewing (placimg a wad of chewing tobacco between the cheek and the teeth and
sucking on it) or dipping (placing a pinch of tobacco called snuff between the lower
lips and teeth) smokeless tobacco causes:
mouth sores
injury to the gum tissue that hold the teeth
white hard patches where the tobacco is held in the mouth
0 bad breath
staining of the teeth
If you use smokelss tobacco for a long time, cancer of the mouth can appear inside
the lip, tongue, palate or cheek.
Care enough about yourself to say "NO" to smokelss tobacco. It's not always easy
to say "NO" but only you can decide what is best for you.
WELLNESS FOR TEENS
TEENAGE DEPRESSION AND SUICIDE
FACT SHEET
Sometimes a person may feel overwhelmed by problems and pressures and feel helpless and hopeless that things will never get
better. This person may become depressed, even suicidal. Knowing the warning signs of depression and suicidal behaviors could
help you or someone else you care about.
WHAT TO LOOK FOR - - - WARNING SIGNS:
Behaviors:
Some of the following behaviors alone and for short periods of time can be normal behaviors that anyone may experience. However,
if someone is experiencing several of them and they are lasting for more than a few weeks, then this could be a warning sign that a
serious problem exists. Warning signs can vary and can include the following:
w Eating and sleeping problems.
n Withdrawing from friends, family and activities.
>> Excessive substance uselabuse.
>> Major or very noticeable change in appearance.
>> Poor concentration andlor concentrates only a problem.
w Mood changes.
>> Risk taking behaviors.
D Unpredictable outbursts of violence or crying.
The following behaviors are serious warning signs that someone may be in crisis:
P Suicidal remarks; gesters or attempts.
>> Preoccupation with death or suicide.
B Giving away possessions.
>> Giving direct and indirect messages that no one cares about them and their life isn't worth living; there is no hope.
>> Sudden forced cheerfulness after a period of depression.
Recent Stressful Sitnations:
When someone experiences a loss or failure, he or she may feel helpless and hopeless, that things will not get better, and that life
has no meaning. If a change in behavior is noticeable and one or more of the following has occurred, this could be a warning sign
that a problem exists. The most common stressful situations include the following: '
w Divorce of parents.
n Loss of a close friend either through death or moving away.
w Death of someone close.
>> Breaking up with boyfriendtgirlfriend.
>> School problems - failing grades or not getting along with a teacher or other schoolmates.
m Trouble with the law.
m Moving to a new school or town.
> Loss of self-esteem.
w Change in body image - injury or physical illness.
> Sexual or physical abuse.
rn Increased fighting with parents andlor brothers and sisters.
> Change in parents' financial status.
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$!IX~A$ i?* .
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>> 5Shoi.- 1 t (;.B ,IY~ 'ref lak per -Qi truitvfi ,; ar f e , 1 : ~ ,vy;. i n:;3n~t a i d that >nur n e iki :nc fcr t hcm. Iracluaie
acbviiics; do ih,inps f hey Iikr to do. BC 14 pa:.
Listen - giae the person your undivided attsntion and the time "hey need to talk about what is bothering them.
D Respect Their Feelings - don't make light of their problem. The situation may not seem serious to you but it is to them and
that's what counts.
)) Involve A Trusted Adult - encourage the person to talk with an adult they trust. Offer to go with them.
w Take Warning Signs And Threats Of Suicide Seriously - insist on getting help. A suicidal person needs professional help.
Don't try to do it alone. If the person will not talk with an adult who can get the help that is needed, then you do it for them.
Offer to go with them.
)) Do Not Leave A Suicidal Person Alone - if you believe the risk for suicide is immediate.
>) Be Direct - ask the person if they have been thinking about suicide. (Askin? about suicide will not suggest the idea of suicide
or encourape someone to follow through with anv attempts. When vou ask directlvvou are checking things out and letting
)) Do Not Promise To Keep Secrets - never agree to keep the person's thought of or threats of suicide a secret. This secret
could mean the life of that person.
>) Safe Environment - secure or remove dangerous items, such as guns and medications.
n Being Caring And Supportive - of a friend or family member is important all the time, but it's especially important when
that person may be depressed. You can help them get the help they need from an adult they trust and/or from professional
people that are trained. Remember however, you cannot solve their ~roblernsfo r them, and you are not responsible for
their behavicrs.
FOR YOURSELF:
,, It's okay "r ask fo: help when ptoblen~sp, aCSc3TCS or 5:ress seems more than you can handle by yourself. It's not a sign of
failure or vcaknesc bcoause you ask f o r help.
)) Your feelings and pt oblems are i~?;pcrtn nt to 5 ou and that's what counts. Try not to think that they may seem stupid or silly
to others and, therefore, no one will understand or listen.
>) If someone should happen to make light of your problem, don't let that stop you from asking for help. Remember: You Are
Arizona Department of Health Srvices
Family Health Services
Office of Women's and Children's Health Services
1740 West Adams, Phoenix, Arizona 85007
AIDS
FACT SHEET
IT DOESN'T MATIlER WHO YOU ARE, IT'S WHAT YOU DO THAT WILL PUT YOU AT RISK OF GE'ITING AIDS.
AIDS stands for: Acquired Immune Deficiency Syndrome, which is a disease caused by a virus known as HIV (Human Im-munodeficiency
Yirus).
How The HIV Effects The Body;
The Helper T-Cell is a type of white blood cell (which is part of our immune system) that helps to fight off organisms that cause
infection and disease. The HIV attaches itself to, invades and attacks the Helper T-Cells. The HIV reproduces itself, thereby
destroying the T-Cell. When the T-Cell is destroyed, the immune system can no longer attack and destroy organisms. As a result,
a person no longer has the resistance to life-threatening infections.
AIDS. It may take many years between being infected and the development of AIDS. Only a doctor can diagnose AIDS when signs
of infection occur. Some people may be infected with the AIDS virus and not know it until symptoms develop. Persons with the
virus can transmit it to others even if symptoms do not develop.
Local health departments provide confidential testing to all persons, including teenagers, at AIDS counseling and testing sites.
More information about AIDS can be obtained from local health departments, doctors, STD (Sexually Transmitted Disease) clinics,
or the state health department at (602) 230-5819. There is an AIDS National Hotline at 1-800-342-AIDS and an Arizona Hotline
at 1-800-334-1540, during the hours of 8 A.M. - 5 P. M.
How The HIV Is Transmittea
AIDS is a blood borne, sexually transmitted disease (STD). It is transmitted by:
w Sexual contact through vaginal secretions and semen.
There is no danger in donating blood, and the blood test available today makes it rare to receive contaminated blood.
The HIV JS NOT Transmitted By:
Casual contact, such as handshakes or touch.
w Hugs or kisses.
n Objects such as toilet seats, door knobs, showers, bathtubs or drinking fountains.
w Coughing or sneezing. Being around people who have HIV infections1AIDS.
n Insect bites.
n Saliva, tears, urine, feces, sweat. (Unless bloody).
Who Can Get AIDS;
Anyone who engages in unprotected sexual behaviors or risky drug-abusing behaviors with an infected person can get the AIDS
virus. Persons with the following behaviors are more likely to be exposed to the AIDS virus:
) Persons who use needles andlor syringes that may have been used by someone else. (This someone else may be infected
with the AIDS virus and not know it!!!).
Persons who have unprotected anallvaginal intercourseloral sex with a male or female partner.
)) Sex partners of persons with HIV infectionIAIDS.
N Sex partners of persons who have high risk behaviors.
D Persons who received contaminated blood or blood clotting factors between the years 1978 and 1985.
n Newborns who acquire the virus from an infected mother during pregnancy or childbirth (rarely through breast milk).
Prevention of AIDS:
AIDS is not curable, but it is reve en table. Persons can reduce their risk of contracting the AIDS virus by:
Not having sex at all.
n Always using a latex condom when having sex (that means any form of sexual intercourse). You may not know your sexual
partners' history and their sexual contacts before you or whether a person is lying about his or her history so always use a
n Not using IV Drugs (if you are using, enroll into a treatment program and get help to stop).
n Not using needles ansd syringes that may have been used by someone else.
Arizona Department of Health Srvices
Family Health Services
Office of Women's and Children's Health Services
1740 West Adams, Phoenix, Arizona 85007
(602) 542-1880
HOW WAS THE AH= PROJECT
IMPLEMENTED?
Pilot Project for
AHRA Refinement
(1988 - 1989)
Pilot testing of the AHRA admin-istration
procedures occurred
during the 1988- 1989 academic
year. The AHRA Project was
piloted at one school near the
end of the 1988-89 academic
school year.
The students at the first two
schools that completed the
AHRA in the 1989-90 academic
year were surveyed for their
ideas and suggestions regarding
health-related topics which they
wanted more information about.
Since the Way to WeUness for
Teens pamphlet did not address
specific Arizona health concerns
(i.e., effects from the sun,
drowning, etc.), the Arizona
Department of Health Services
developed Wellness for Teens to
provide additional information
based on student feedback and
questions. In addition, student
input and discussion also led to
the development of two fact
sheets: Wellness For Teens-
Teenage Depression and Suicide
and Wellness For Teens- AIDS.
As a result of the pilot testing,
several policies and procedures
were implemented for purposes
of the Project's completion.
Methods of AHRA
Project
Administration
(1989 -1991)
Participant Recruitment
The AHRA was exhibited at the
Arizona School Nurses
Association Conference, School
Nurse Supervisor Meetings, and
the Arizona School Health
Association Conference. These
conferences and meetings pro-vided
opportunities to target the
appropriate school personnel
who might be interested in the
project. Informational packets
about the AHRA Project were
available to anyone who was
interested in the administration
of the AHRA at their school.
For conference participants who
took an informational packet, a
sign-up sheet was provided.
They were to leave their name,
their school's name, address
and a contact phone number.
They were informed that they
would be contacted during the
school year as to whether they
were still interested and/or
wanted to coordinate the AHRA
Project at their school. It was
through this type of exposure at
the conferences and also
through "word of mouth" that
schools within the state of
Arizona became informed about
the AHRA and ultimately
became involved in the adminis-tration
of the AHRA Project at
their school.
The AHRA information packets
available at conferences and
upon request from the
Department of Health Services
contained the following informa-tion
(see Appendix D):
* The Adolescent Health Risk
Appraisal Fact Sheet
* ADHS Protocol For School
Selection For The AHRA
* AHRA Project Policies
* Adolescent Health Risk
Appraisal Program Request
Form for 8th and/or 9th
Grades
* Sample Parent Letter
* Copy of The Teen Wellness
Check Questionnaire
* Samples of School Data
Teen Wellness Check
Advisory Messages
* Samples Teen Wellness
Printouts
One "Excellent" Appraisal
One "Risky" Appraisal
* The Rhode Island
Department of Health
booklet The Way to
Wellness for Teens
* The ADHS booklet Wellness
For Teens
* Resources in Arizona For
Teens Phone List
* Wellness For Teens-Teenage
Depression And Suicide
Fact Sheet (optional)
* Wellness For Teens-AIDS
Fact Sheet (optional)
Tickler Filing System
As a means to track AHRA
requests and scheduled schools,
a tickler filing system was uti-lized.
Index cards requiring the
following information were devel-oped:
Appendix E. 1
Pertinent Demographic
Information
School name
School address
School phone number
School district information
Travel directions to the
school
Personnel Information
Name of Principal
Name of the School Nurse or
Ilealth Aid
Names of the identified staff
for referrals
Teacher(s) with participating
8th and 9th graders
MIRA School Project
Coordinator